磁共振成像对炎性肠病诊断及病情评估的价值探究

Value of magnetic resonance imaging in the diagnosis and evaluation of inflammatory bowel disease

目的应用MRI平扫、增强MRI结合扩散加权成像(DWI)探究各MRI指标对炎性肠病(IBD)的诊断效能及其在量化评估IBD炎症程度中的价值。方法选取病理确诊为IBD的20例患者及10例肠镜正常体检患者。分析各肠段MRI节段性评分(MR-score-S),测量各个肠段(直肠、乙状结肠、降结肠、横结肠、升结肠和回肠)的ADC值及肠壁厚度。以内镜结果为金标准,通过ROC曲线分析各个指标对炎性肠病的诊断效能,同时分析其与内镜分级结果的相关性。结果本研究共分析162个肠段。ROC曲线分析结果显示,MR-score-S、ADC值和肠壁厚度诊断IBD的ROC曲线下面积分别为0.8126,0.7654和0.74;MR-score-S(无增强)、MR-score-S(无DWI)和MR-score-S(无增强及DWI)的ROC曲线下面积分别为0.785,0.7988和0.7377。在IBD患者中,MRI评分、ADC值、肠壁厚度与IBD内镜分级结果均具有相关性,差异均具有统计学意义(P<0.05),溃疡性结肠炎(UC)患者各指标的相关系数分别为0.724、-0.43和0.519;而克罗恩病(CD)患者分别为0.484、-0.392和0.331。结论MRI平扫结合DWI、增强MRI为IBD特别是UC患者提供了一种可靠的诊断及定量评估病情的检查方法,从而更好地指导临床进行个性化治疗,改善预后。

】Objective To investigate the diagnostic efficiency of MRI combined with diffusionweighted imaging(DWI)in diagnosis and quantitative evaluation of inflammatory bowel disease(IBD)Methods 20 patients with pathologically diagnosed IBD and 10 patients with normal enteroscopy examination were collected.The MR-score-S of each intestinal segment was analyzed,and the ADC value and intestinal wall thickness was also measured(rectum,sigmoid colon,descending colon,transverse colon,ascending colon and ileum).Using endoscopy as the golden standard,diagnosis efficiency of IBD by quantitative parameters including MR-score-S,ADC value and intestinal wall thickness was analyzed by ROC curve and their correlation with endoscopy scores was also analyzed.Results 162 intestinal segments were analyzed.The area under the ROC curve of MR-score-S,ADC value and the thickness of the bowel wall in diagnosis of IBD was 0.8126,0.7654 and 0.74,respectively.That of MR-score-S(Without enhancement),MR-score-S(Without DWI)and MR-score-S(Without enhancement or DWI)was 0.785,0.7988 and 0.7377,respectively.In IBD patients,MR score,ADC value and bowel wall thickness showed statistical correlation with endoscopic grading(P<0.05),and the correlation coefficients were 0.724,-0.43 and 0.519 in UC patients,while those in CD patients were 0.484,-0.392 and 0.331.Conclusion Combined with DWI and ADC value,MRI provides a reliable diagnostic method for IBD,especially in patients with ulcerative colitis.And quantitative assessment of bowel inflammation helps to guide clinical individualized treatment and improve the prognosis of IBD.