磁共振肠道成像技术在克罗恩病和肠结核鉴别诊断中的作用

Magnetic Resonance Enterography Differentiates Intestinal Tuberculosis from Crohn’s Disease in Chinese Patients with Ileocecal Disease

目的探讨磁共振肠道成像技术在克罗恩病和肠结核鉴别诊断中的作用。方法连续招募2014年12月至2018年6月我院消化内科回盲部溃疡患者。所有被研究者均进行磁共振肠道成像(MRE)检查,并收集被研究者的症状、体征、实验室检查、胸部CT、肠镜及活检标本形态学评估、抗酸染色及TB DNA检查。结果本研究连续筛选到166名符合研究要求的患者,最终招募了其中120名。120位被研究者中有75位的MRE图像有异常表现。与非肠结核患者相比,肠结核患者MRE显示回肠末端受累(100%vs 71.0%,P<0.05)和盲肠受累(53.8%vs 9.7%,P<0.05)比例明显增加,但未见多节段性病变(0%vs 37.1%,P<0.05),纤维脂肪增生(15.4%vs 50%,P<0.05),“梳状征”(0%vs 35.5%,P<0.05)和肠壁分层增强(30.8%vs 67.7%,P<0.05)。在多因素分析中,MRE显示盲肠受累发生率增加(P=0.021,OR 17.5)和肠壁分层增强发生率减少(P=0.025,OR 19.6)是肠结核的独立相关因素。结论独特的MRE特征有利于克罗恩病和肠结核的鉴别诊断。

Objective To explore magnetic resonance enterography differentiates intestinal tuberculosis from Crohn’s disease in Chinese patients with ileocecal disease.Methods We prospectively recruited consecutive Chinese patients presenting with colonoscopy showing ileocecal mucosal lesions of undetermined diagnosis.We arranged MR enterography performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens Healthcare,Erlangen,Germany)for all patients.Intestinal TB and Crohn’s disease were diagnosed via standard criteria,and validated via subsequent clinical and endoscopic assessment of treatment response.Results Among 166 consecutively screened patients,120(72.3%)were recruited.Abnormal MR enterography findings were noted in 75(72.2%)patients.ITB patients,when compared to patients without ITB,had significantly more MR terminal ileal involvement(100%vs.71.0%)and cecal involvement(53.8%vs.9.7%),but significantly less multi-segmental involvement(0%vs.37.1%),fibrofatty proliferation(15.4%vs.50%),engorged vasa recta(0%vs.35.5%),and stratified bowel wall enhancement(30.8%vs.67.7%)(all P<0.05).On multivariate analysis,increased MR cecal involvement(P=0.021,OR 17.5)and fewer stratified bowel wall enhancement(P=0.025,OR 19.6)was independently associated with the development of ITB.Conclusion Distinctive MR enterography features can aid the differentiation of intestinal tuberculosis from Crohn’s disease.