结构化报告对克罗恩病CT肠造影诊断的影响

Effect of structured report on the diagnosis of Crohn’s disease by CT enterography

目的探讨结构化报告(SR)对克罗恩病(CD)CT肠造影(CTE)诊断的影响。方法回顾性纳入浙江省嘉兴市第二医院2020年3月至2021年10月223例同时接受CTE和内镜检查的疑似或确诊CD患者。根据CTE报告格式将其分SR组(103例)和叙述性报告(NR)组(120例)。以肠镜或胶囊内镜及病理结果为金标准,比较两组CTE报告的灵敏度、特异度、阴性预测值及阳性预测值;比较两组CTE综合评分、克罗恩病活动指数(CDAI)评分,同时分析CTE评分与CDAI评分的相关性;两组中以抽签法各抽取25份报告,统计关键词出现的频次;对7名临床医师进行问卷调查,比较临床医师对两种报告模式的满意度。结果SR组诊断CD的灵敏度、特异度、阳性预测值及阴性预测值高于NR组,差异有统计学意义(P<0.05)。两组CDAI评分比较,差异无统计学意义(P>0.05);SR组CTE综合评分高于NR组,差异有统计学差异(P<0.05)。SR及NR中CTE综合评分与CDAI评分呈正相关(r=0.884、0.651,P<0.05)。SR中出现频率最高的为发病部位、强化模式、平扫密度、增强后强化程度(动脉期)、增强后强化程度(静脉期),其次为肠病增厚及增厚程度;NR中出现频率最高的为发病部位,其次为强化模式。临床医师对SR满意度总评分高于NR,差异有统计学意义(P<0.05)。结论SR能有效提高CTE对CD的诊断效能,减少漏诊及误诊的风险,为临床提供准确高效的评估。

Objective To explore the effect of structured report(SR)on the diagnosis of Crohn’s disease(CD)by CT enterography(CTE).Methods A retrospective study was conducted on 223 suspected or confirmed CD patients who underwent both CTE and endoscopic examinations at the Second Affiliated Hospital of Jiaxing University,Zhejiang Province from March 2020 to October 2021.According to the CTE report format,they were divided into SR group(103 cases)and narrative report(NR)group(120 cases).The sensitivity,specificity,negative predictive value,and positive predictive value of CTE reports were compared between two groups using colonoscopy or capsule endoscopy and pathological results as the gold standard;the CTE comprehensive score and Crohn’s disease activity index(CDAI)score reported were compared between two groups,and the correlation between CTE score and CDAI score was analyzed;in the two groups,25 reports were selected by drawing lots,and the frequency of keyword occurrence was counted;and a questionnaire survey was conducted among seven clinicians to compare their satisfaction with two reporting modes.Results The sensitivity,specificity,positive predictive value,and negative predictive value of CD diagnosis in SR group were higher than those in NR group,and the differences were statistically significant(P<0.05).There was no significant difference in CDAI score between two groups(P>0.05);the CTE score in SR group was higher than that in NR group,and the difference was statistically significant(P<0.05).CTE scores in SR and NR were positively correlated with CDAI scores(r=0.884,0.651,P<0.05).The most frequent occurrence of SR was the location of disease,the pattern of enhancement,the density of plain scan,the degree of enhancement after enhancement(arterial stage),and the degree of enhancement after enhancement(venous stage),and followed by the thickening,and thickening degree of intestinal disease;the highest frequency of NR occurred in the site of disease,followed by the enhancement mode.The total satisfaction score of SR was higher than NR,and the difference was statistically significant(P<0.05).Conclusion SR can effectively improve the diagnostic efficiency of CTE for CD,reduce the risk of missed diagnosis and misdiagnosis,and provide accurate and efficient evaluation for clinic.