多层螺旋CT 及消化内镜对克罗恩病诊断的价值[J].pdf

nullnull(临床研究)CT#h=X6hN朱庆强,朱文荣,史玉振,童明敏,林艳飞,王中秋nullnullK1nullnull?h_X6h1ZEB,VAU:#axFhM,hMC#i?ilvb|CT(multinullslicespiralcomputedtomography,MSCT)h=M,)MSCT#h=X6hN#KbnullZEnullhamX6hMSCTh=VC$sbnullTnull24MSCT_?C,22(91.7%)VCC9(4mm),20(81.3%)2030HU),20(83.3%)hM,22(91.7%)8?5.N,10(41.7%)u%v(5mm),7(29.2%)u59a9Y,14(58.3%)5,9(37.5%)8=h,6(25%)8=v,12(50%)E,9(37.5%8A),6(25%)5,AUCLxFb18h=_?C,12(66.7%)VC:#,14(77.8%)FxF,16(88.9%)8?5.N,14(77.8%)hM,?CC#i?bnullnullMSCTVAUhMC#i?,4AUCLxFbh=AUC*:#xFM,4AUC#5i?bVX6h5bnullnull1oMnullX6h；CT；h=；kYnullnullms|nullR574.62nullnullnullDSnullAnullnullnullcI|null1008null8199(2011)02null0182null05T:221000,D3i4mm)wasmanifestedin22(91.7%),innullcreasedenhancementoftheintestinalwal1(20-30HU)in20(83.3%),skiplesionsin22(91.7%),mesangialregionlymphnulladenectasis(5mm)in10(41.7%),vascularbundlethickeningin7(29.2%),dermatocellulitisin14(58.3%),peritonealabscessin9(37.5%),phlogoticlumpin6(25%),incompleteintestinalobstructionin12(50%),andseroperitoneumin9(37.5%),butintestinalwalllinearulcersandcobblestonesshowninnone.Amongthe18casesthatreceiveddigestiveendoscopy,longitudinalfissureulcersweremanifestedin12(66.7%),cobblestonesin14(77.8%),irregularentericcavitystenosisin16(88.9%),andskiplesionsin14(77.8%),butintestinalwallandextranullintestinalcomplicationsofCrohnnullsdiseaserevealedinnone.nullConclusionnullTheMSCTcandemonstrateexactlythediseasedintestinalwallandextranullintestinalcomplicationsofCrohnnullsdisease,butnotlongitudinalfissureulcersandcobblestonesoftheintestinalwal1.Digestiveendoscopycaneasilyrevealsuchcharacteristicchangesaslongitudinalfissureulcersandcobblestones,butnotextranullintestinalinflammatorymassandabscess.ThecombinationofthetwodiagnosticmeansmaygiveacompletepicturefortheclinicaldiagnosisofCrohnnullsdisease.nullnullKeywordsnullCrohnnullsdisease；MultinullslicespiralCT；Digestiveendoscopy；Differentialdiagnosis0nullnullnullnullnullX6hKa,1&faL.ay1d+s%h,z?#,#gV#bX6h182D32011M2242nullJMedPostgra,Vo.l24,No.2,February,2011Fs,9MSCTh=VC,s2_ZEX6hNKb1nullZE1.1null临床资料null2+u29D2008M32010M728X6h(hamb316,o12bM-1452(32.5!8.4)be22,16,L2,!12,E13,v8b_ZEMSCT24,h=18,HMSCT#h=_14b1.2null检查方法1.2.1null全腹部CT平扫加增强null064CT(SomatomDefinition)b5,9bHq:640.6mm,OHW0.5s,1.4,5120kVp,I5230mAs；7LH；4,48n(CombinedApplicationReduceExposure,CARE)44Db1y0.75mm,yW0.5mmbc(iopromide,A)80100m,lq4ml/s,q330mlb1420s,40s,5min,HW?(?d,5120kv,5230mA/sb1.2.2null消化内镜检查null_-1dJ,_J12hb7ggh4gJb9g20%?250ml50%；50mlivbb_-10min9J(prthinulldinehydrochloride,)50mg,Ea10mg,10mgb_V5%$AimaSb_VH4ib1.3nullMSCTa消化内镜的表现与病理学检查结果的对照分析nullMSCTVC$sbm(210MCT#hS=MD=E,TBH)Bbh_TMSCTah_T1b1:Ca#axFa8.N；u%a5；8hava5aah,da8AaEi?bhS；4b1.4null统计学分析nullSPSS10.0qb9s1VU,NMSCT#h=X6ha+sbu_1MSCTh=2ZEX6hs,P#0.05sd9ilb2nullnullnullT2.1nullMSCTnull24MSCTF94mm)22,nm1a,415mm,410mm16,1015mm8b9AU20AU9F,VC(,nm1a,sCT19F1020HU,2030HU,30HU5mm)10,nm1b,u59a9Y7,nm1C,514,v6,nm2,E12,nm3,8=h9,nm4b8A9b2.2null消化内镜null18h=_,:#12,nm5,FxF14,nm6,8?5.N16,nm7bm1null9MSCTAU5#uFigure1nullAbdominalenhancedMSCTofthebowelandmesangialregionnullnullnulla:UCW9,C(,uv%；b:3y(multiplanarreformation,MPR)UuC9,u%v,59,9Y；c:KvgE(maximumintensityprojection,MIP)mAUu59,9Y,E,%v183D32011M2242nullJMedPostgra,Vo.l24,No.2,February,2011m2null9MSCTAUvFigure2nullAbdominalenhancedMSCToftheinflammatorymassnullnullnulla:Uv,(；b:3MPRUvAm3null3U8faaA,ChFigure3nullMPRshowingintestinalexpasion,pneumatosisandfluidwithweakenedenhancementofthebowelwallm4nullX6h,hFigure4nullAbscessinformationintherightillacfossaaftersurgeryofileocecalCrohnnullsdiseasem5nullU?Figure5nullDigestiveendoscopyshowingmultipleileocecalulnullcerationm6nullUFxFFigure6nullDigestiveendoscopyshowingcobblestonesintheileocecaljunctionm7nullU58?5.NFigure7nullDigestiveendoscopyshowingirregularintestinalstenosisnullnullMSCT_TbAUX6hC#i?,h2#+s,h=C#i?(AU,2_ZEqAs(P0.05)bh=_VbAU:#xFX6h+hM,h2184D32011M2242nullJMedPostgra,Vo.l24,No.2,February,2011#+s,MSCT?AUthM(P0.05),nV1a2bV1nullMSCT#h=X6h+sTable1nullSpecificityandsensitivityofMSCTanddigestiveendoscopyinthediagnosisofCrohnnullsdisease_ZE(n)58(n)|(n)L(n)L|(n)(%)+s(%)MSCT(24)C9222001001009F20200100100u%v1012119192u5971421888881471288888h911319079v616118694h=(18)5.N16200100100:#1251092100xF1431010075V2null16MSCTh=X6hhMAUqn(%)Table2nullCombinationofMSCTanddigestiveendoscopyinthediagnosisof16casesofCrohnnullsdiseasen(%)hM+MSCT(n=16)h=(n=16)#0(0%)*12(75.0%)nullxF0(0%)*12(75.0%)null?58.N14(87.5%)14(87.5%)hM14(87.5%)14(87.5%)C914(87.5%)0(0%)nullnull9F12(75.0%)0(0%)nullnull9(56.3%)*0(0%)nullnullE8(50.0%)0(0%)nullnull8A6(37.5%)0(0%)nullnullv4(25.0%)0(0%)nullnull8h6(37.5%)*0(0%)nullnullu%v7(43.7%)0(0%)nullnullu594(25.0%)0(0%)nullnullnullnullFW1,*P4mm,410mm16,1015mm8b9C,C92,7C,h_?CBhM+BbKnollmann3CsVQhM5S,hM+sVCb14AU,#hMCA#C,lCsb209#CM19FAbCTVb#AUhM5i?,)/y(volumerenderingtechnique,VRT)aMPRaMIP5hMAUF4bX6h,iC5,MSCTVC9C9F,Hb,9Vnnull4b5y759a9Y,893,u%v5,3y#MIPAU5%x6,u%v,#5sMb,K,Hb#a(v,u5(hb5,MSCTVb#AU5CW5a,5W=AUqb24MSCT514,58.3%,8h9(37.5%),v6(25%),56(25%)bVnX6havhbMSCTEX6h91N7bsX6hEn1,E8ivA8,.dXLl94Eyb7MSCT,3y/VAUEf5,V?CEahy,V7kY?Eby?EVnHbvKC9,9,7hMEv,EC95?5.N,9Cb9Y,9,%v,59bVnC9sMb:s)SU+s%h,z?Mo,n10bXL_VnC(9,*9Yy,T,#bCT_VnC9,#uv%,u59afaew11b=_VnnM12,Lb(l0%?:%?%F0?,20%?3%F2,hKn,z?13,CT1VCC9a8Ma5f.Na8=Fvb?A,yV?C$?5,9AU?,i?HVn%db4nullnullnullnullnullTV,MSCT?AUC*LxF,VbAUC9a*snullZ,.XLaCTMRIlCrohnhNNJ.SD9,2005,11(3):184null189.5nullJenschS,deVriesAH,PeringaJ,etal.CTcolonographywithlminullitedbowelpreparation:performancecharacteristicsinanincreasedriskpopulationJ.Radiology,2008,247(5):122null132.6nullLeeYJ,YangSK,ByeonJS,etal.AnalysisofcolonoscopyicfindingsinthedifferentialdiagnosisbetweenTBandrohnullsdiseaseJ.Endoscopy,2006,38(6):592null597.7nullnull,null,.CTy/EJ.D3,2008,21(1):51null53.8null,T,a.5=lX6hJ.h=,2004,21(6):96null99.9nullnull0,Y,null,.l；,?hJ.D3,2010,23(2):141null144.10nullMarkoseG,NgCS,FreemanAH:Theimpactofhelicalcomputedtomographyonthediagnosesofunsuspectedinflammatoryboweldiseaseinthelar