摘要
Background and aims:The differential diagnosis between Crohn’s disease(CD)and ischemic colitis(ISC)is important as their clinical management is different.ISC can easily be misdiagnosed as CD,especially in elderly populations.The distinctive radiographic features of the two disease entities have not been investigated.The aim of this study is to assess the utility of computed tomographic enterography(CTE)in the differential diagnosis between CD and ISC.Methods:Patients with confirmed CD and ISC were identified through an electronic medical record search of the Cleveland Clinic Foundation.Patients who had undergone CTE,with or without concurrent colonoscopy and histopathological specimens,were included in this study.CTE images were blindly re-reviewed by an expert gastrointestinal radiologist.The sensitivities,specificities,accuracies and positive and negative predictive values for each of the CTE findings in differentiating CD from ISC were estimated.Kappa coefficients(j)were calculated tomeasure diagnosis agreement between CTE and the reference standard.Results:A total of 34 eligible patients were included in this study with 17 having CD and 17 having ISC.In differentiating CD from ISC,the presence ofmucosal hyperenhancement and absence of the“target sign”on CTE showed a sensitivity of 100% each for CD,while the two radiographic features yielded a low specificity of 35.3%and 76.5%,respectively.The presence of stricture had a lower sensitivity of 64.7% for the detection of CD but had a high specificity of 100%.In distinguishing CD fromISC,the accuracy of presence ofmucosal hyperenhancement,stricture and absence of target sign were 67.7%,82.4% and 88.2%,respectively.The combination of the presence ofmucosal hyperenhancement and the absence of the target sign achieved an accuracy of 100%for distinguishing CD from ISC.There was a good correlation between CTE and the reference standard for distinguishing CD fromISC(k=0.882).Conclusions:CTE appeared to be clinically useful in distinguishing CD from ISC.
背景与目的:由于克罗恩病(CD)与缺血性结肠炎(ISC)的临床处理不同,因此对这两种疾病的鉴别诊断是非常重要的。ISC易被误诊为CD,尤其是对于老年人群。这两种疾病各自的影像学特征尚未被发明了。本研究的目的是评估CT小肠造影(CTE)用于CD与ISC鉴别诊断的价值。方法:通过Cleveland Clinic Foundation的电子医疗记录,检索确诊为CD和ISC的病例。入组其中接受过CTE检查者,无论其是否同时接受了肠镜和组织病理检查。由一名胃肠影像学专家盲法重新阅读CTE图像。计算每一项CTE影像学特征鉴别CD与ISC的灵敏度、特异度、准确性、阳性预测值及阴性预测值。采用Kappa系数(κ)来评估CTE与参考标准的诊断一致性。结果:共计34例患者纳入研究,其中CD 17例,ISC 17例。对CD与ISC进行鉴别诊断,CTE图像中黏膜强化和“靶征”缺失诊断CD的灵敏度均为100%,但这两种影像学特征的特异度较低,分别为35.3%和76.5%。CTE图像中的狭窄诊断CD的灵敏度仅为64.7%,但其特异度高达100%。黏膜强化、狭窄、“靶征”缺失鉴别CD与ISC的准确性分别为67.7%、82.4%和88.2%。联合应用黏膜强化和“靶征”缺失,其鉴别诊断的准确性可达100%。在鉴别CD与ISC方面,CTE与参考标准具有较好的一致性(κ=0.882)。结论:在鉴别CD与ISC方面,CTE似乎具有较高的临床价值。
