合并直肠炎肛周克罗恩病MRI影像特征分析

MRI imaging features of perianal Crohn's disease patients with proctitis

目的探讨合并直肠炎与未合并直肠炎患者肛周克罗恩病的MRI影像特征差异。方法回顾性分析2017年9月—2021年7月扬州大学附属医院及南京中医药大学附属医院57例肛周克罗恩病患者临床资料,均于入院1个月内进行结肠镜检查及肛周MRI检查。根据患者炎症是否累及直肠分为直肠炎组和非直肠炎组,分别测量直肠壁厚度、直肠壁的表观扩散系数(apparent diffusion coefficient,ADC)、直肠壁的T2信号强度,是否高位瘘管内口(瘘口位于直肠视为高位),有无肛提肌上瘘管,有无肛提肌上脓肿。结果独立样本t检验示直肠炎与非直肠炎组直肠壁厚度及ADC值差异均存在统计学意义(P<0.001);χ^(2)检验示直肠炎组T2信号中-重度增高比率显著高于非直肠炎组(χ^(2)=18.426,P<0.001);Fisher确切概率法示2组高位内口发生率差异有统计学意义(P=0.044),肛提肌上瘘管及肛提肌上脓肿发生率差异均无统计学意义(均P>0.05)。结论与未合并直肠炎的肛周克罗恩病比较,合并直肠炎的肛周克罗恩病患者MRI表现具有一定的特异性。

Objective To investigate the MRI imaging features of perianal Crohn's disease patients with and without proctitis.Methods A total of 57 perianal Crohn's disease patients in the Affiliated Hospital of Yangzhou University and the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2017 to July 2021 were enrolled and their clinical data were retrospectively analyzed.According to their rectal inflammation,they were divided into two groups:a proctitis group and a non-proctitis group.The thickness,the apparent diffusion coefficient(ADC),and the T2 signal intensity of the rectal wall were measured,respectively.Furthermore,the location of fistula(whether its opening was connected to the rectum),and the presence of a fistula or abscess on the levator animuscle were also evaluated.Results The independent sample t-test showed that there were significant differences in rectal wall thickness and ADC between the proctitis and non-proctitis groups(P<0.001).Chi-square test results revealed that the ratio of moderate to severe increase of T2 signal was significantly higher in the proctitis group than that in the non-proctitis group(χ^(2)=18.426;P<0.001).Fisher's exact probability method indicated that there was statistical difference in the incidence of high fistula(P=0.044),without statsitcal differences in the incidence of fistula and abscess on levator ani muscle between the two groups(all P>0.05).Conclusions Perianal Crohn's disease patients with proctitis are characteristic in MRI images,compared with those without proctitis.