CTE综合评分联合能谱成像诊断克罗恩病活动期的效能分析

Diagnostic efficiency of CT enterography comprehensive score combined with spectral imaging for Crohn's disease in active phase

目的探讨CT小肠造影(CTE)综合评分联合能谱成像诊断克罗恩病(CD)活动期的效能。方法回顾性分析2018年10月至2020年10月郴州市第一人民医院接收的87例CD患者的病例资料,根据CD活动性指数(CDAI)分为活动期(n=58)、缓解期(n=29),收集2期CD患者CTE、能谱成像检查结果,分析CTE综合评分联合能谱成像对CD活动期的诊断价值。多元线性逐步回归分析影响CD活动期的独立相关因素,ROC曲线分析CTE综合评分联合能谱成像相关指标(肠壁厚度、肠壁均匀强化、门脉期碘浓度)预测CD活动期的AUC、灵敏度、特异度、截断值。结果活动期CD患者CTE检查出现梳状征、肠腔狭窄或扩张、靶征的概率显著高于缓解期CD患者,出现脂肪征的概率显著低于缓解期CD患者,CTE综合评分显著高于缓解期患者(P<0.05)。多元线性逐步回归分析提示,能谱成像中肠壁厚度、肠壁均匀强化、门脉期碘浓度是影响CD活动期的独立相关因素(P<0.05)。ROC曲线分析显示,CTE综合评分联合能谱成像中肠壁厚度、肠壁均匀强化、门脉期碘浓度四者联合预测CD活动期的AUC为0.953,高于单独检测的0.869、0.907、0.914、0.913,此时CTE综合评分、肠壁厚度、门脉期碘浓度的截断点分别为6.0分、0.89 cm、2.68 mg/ml,能谱成像不可见肠壁均匀强化。结论CTE综合评分联合能谱成像中的肠壁厚度、肠壁强化方式、门脉期碘浓度可以为CD活动期提供诊断价值,提供了一种新型定量诊断参考。

Objective To explore the diagnostic efficiency of CT enterography(CTE)comprehensive score combined with spectral imaging for Crohn's disease(CD)in active phase.Methods A retrospective analysis was performed on the case data of 87 CD patients who were admitted to the First People's Hospital of Chenzhou from October 2018 to October 2020.According to CD activity index(CDAI),they were divided into active phase group(n=58)and remission phase group(n=29).The results of CTE and spectral imaging in both groups were collected.The diagnostic value of CTE comprehensive score combined with spectral imaging for CD in active phase was analyzed.Multiple linear stepwise regression analysis was used to analyze the independent related factors affecting the active phase of CD.Receiver operating characteristic(ROC)curve was used to predict the area under curve(AUC),sensitivity,specificity and cutoff value of CTE comprehensive score combined with energy spectrum imaging(intestinal wall thickness,intestinal wall uniform enhancement and iodine concentration in portal phase)in active phase of CD.Results The probability of comb sign,intestinal stenosis or expansion and target sign in CTE of patients with active CD was significantly higher than that in patients with remission CD,the probability of fat sign was significantly lower than that in patients with remission CD,and the CTE comprehensive score was significantly higher than that in patients with remission CD(P<0.05).Multiple linear stepwise regression analysis showed that the thickness of intestinal wall,uniform enhancement of intestinal wall and iodine concentration in portal phase were independent related factors affecting the active phase of CD(P<0.05).ROC curve analysis showed that AUC of CTE comprehensive score combined with intestinal wall thickness,intestinal wall uniform enhancement and iodine concentration in portal phase for predicting CD in active phase was 0.953,higher than 0.869,0.907,0.914 and 0.913 of single index.The cut-off values of CTE comprehensive score,intestinal wall thickness and iodine concentration in portal phase were 6.0 points,0.89 cm and 2.68 mg/ml,respectively.There was no homogeneous enhancement of intestinal wall in spectral imaging.Conclusions CTE comprehensive score combined with intestinal wall thickness,intestinal wall enhancement and iodine concentration in portal phase can more accurately determine CD in active phase,which provide a new quantitative diagnostic reference.