摘要
目的：肠道狭窄是克罗恩病的并发症之一，不同原因需采取不同的治疗方案。文中旨在运用磁共振弥散加权成像（ diffusion-weighted imaging ， DWI）对克罗恩病狭窄肠段进行研究，探讨该方法对于克罗恩病继发肠道狭窄性质的判定价值。方法收集2014年1月至同年6月，经南京医科大学第二附属医院肠镜检查、并病理确诊的31例克罗恩患者，男18例、女13例，年龄21～71岁，平均（38．90±13．65）岁。所有患者均接受3．0 T磁共振常规序列和弥散加权序列扫描。根据患者常规磁共振平扫的表现判断狭窄最严重的肠段，行弥散加权序列检查，并测量该病变段肠壁的表面扩散系数。所有患者在24 h内接受结肠镜检查。根据肠镜表现和病理结果将31例患者分为炎性狭窄组（ n＝21）和纤维性狭窄组（ n＝10）。观察组间表面扩散系数差异并计算截断点。结果炎性狭窄组病变段肠壁的表面扩散系数值为（1．01～1．83）×10^3mm^2／s，平均（1．40±0．23）×10^3 mm^2／s；纤维性狭窄组为（0．53～1．03）×10^3 mm^2／s，平均（0．80±0．16）×10^3 mm^2／s。组间比较差异有统计学意义（P＜0．05）。受试者工作特征曲线曲线下面积为0．981（95％CI 0．943～1．000），将1．11×10^3 mm^2／s 作为截断点，对炎性狭窄判断的敏感性和特异性分别为90．5％和100％。结论由于不同病理成份对水分子运动的限制程度不一，故通过测量表面扩散系数可以得到定量参数，有助于DWI对克罗恩病继发肠道狭窄性质的鉴别诊断。
[Abstract ] Objective Stenosis is a common complication of Crohn′s disease （CD）, different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging（DWI） and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD （18 males and 13 females;mean age：38.90 ±13.65 years） were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient （ADC） of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group （n=21） and fibrotic group （n=10）. We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were （1.01 ±1.83） ×10^3 mm^2/s and （1.40 ±0.23） ×10^3 mm^2/s, whereas （0.53 ±1.03）×10^3 mm^2/s and （0.80 ±0.16）×10^3 mm^2/s in the fibrotic group（P〈0.05）.The area under receiver operating characteristic curve was 0.981 （95%confidence interval 0.943-1.000）, taking 1.11 ×10^3mm^2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.
出处
《医学研究生学报》
CAS
北大核心
2015年第5期498-501,共4页
Journal of Medical Postgraduates
基金
江苏省省级条件建设与民生科技专项资金(BL2014097)
关键词
克罗恩病
炎性肠道狭窄
纤维性肠道狭窄
弥散加权成像
表面扩散系数
磁共振成像
Crohn′s disease
Inflammatory bowel stenosis
Fibrotic bowel stenosis
Diffusion-weighted imaging
Apparent diffusion coefficient
MRI
