摘要
目的探讨能谱CT单能量小肠成像应用于克罗恩病临床评估的价值。方法48例临床确诊为克罗恩病的患者行腹部CT能谱成像。原始图像经信号-噪声比(CNR)分析获得最佳成像Kev值,重建单能量图像。观察指标包括病变肠管位置、肠壁厚度、肠管狭窄程度、肠管强化程度、肠壁周围表现(浆膜层、脂肪间隙、系膜血管)、淋巴结肿大及相关并发症;计算正常肠壁与病变肠管动、静脉期强化率△A%与△V%。所有患者行内镜(结肠镜或小肠镜)检查,2例患者行手术治疗,金标准为活检病理。结果 (1)能谱CT单能量成像结合物质分离功能清晰显示病变肠管范围,病变肠段共132处,肠壁厚度3.1-26mm。病变累及空肠9例,回肠39例,回盲部42例,结直肠29例;25例显示肠壁水肿、增强同心圆样或分层样改变,39例浆膜层毛糙,18例显示肠管周围脂肪间隙模糊,36例显示肠系膜血管增多征象,其中24例有明显的"梳齿"征表现。22例显示肠系膜及腹膜后淋巴结增大,淋巴结大小约3.5-14.5mm。1例出现肠管穿孔,腹腔脓肿形成;3例肛瘘,4例不全小肠梗阻,2例有肠管狭窄伴胶囊内镜滞留。(2)平扫CD病变肠壁与正常肠壁CT值无显著性差异(P>0.05),动脉期、静脉期CD病变肠壁强化程度及强化率均显著高于正常节段肠壁(P<0.01);病变节段肠壁动脉期与静脉期肠壁强化率无显著性差异(P>0.05)结论能谱CT单能量小肠成像对克罗恩病的诊断、临床评价具有明显优势,可作为CD的首选影像学检查方法。
Objective To evaluate the value of CT enterography with spectral monochromatic imaging for Crohn＇s disease.Methods 48 cases of clinically diagnosed Crohn＇s disease underwent CT spectral imaging. Contrast-to-noise ratio （CNR） analysis was performed to obtain the best monochromatic imaging. Observation indicators include intestinal lesions position, intestinal wall thickness, intestinal stenosis, intestinal enhancement level, manifestation around intestine （serosal layer, fat space, mesentery vascular）, lymph node enlargement and related complications. Enhancement rate of normal bowel wall and lesions in the segments of intestine on arterial phase（△A%） and venous phase（△V%） were calculated. All patients underwent endoscopic （colonoscopy or endoscopy） examination, 2 patients underwent surgical treatment.Results CT enterography with spectral monochromatic imaging combined with material separation function could clearly display the intestinal lesions range and position and revealed a total of 132 lesions of the bowel segment. The intestinal wall thickness was between 3.1 to 26 mm. The jejunum were involved in 9 cases, 39 cases of ileal involvement and ileocecal involvement in 42 cases, colorectal lesion of 29 patients. 25 cases displayed bowel wall edema and enhancement of concentric circles or layered like change, 39 cases displayed fuzzy of serous layer, 18 cases displayed fuzzy of fat space around the intestine, 36 displayed increasing of mesenteric vessel, in which, 24 cases were observed obvious ＂comb like＂ sign. 22 cases were observed having mesenteric and retroperitoneal lymph node enlargement. Complications included Intestinal perforation with abdominal abscess formation occurred in one patient, anal fistula occurred in 3 cases and incomplete intestinal obstruction in 4 cases, 2 cases bowel stenosis with retention of capsule endoscopy. CT value of intestinal wall lesion and normal intestinal wall had no significant difference （P〉0.05） on plain scan image. Intestinal wall l
出处
《中国CT和MRI杂志》
2016年第6期95-97,107,共4页
Chinese Journal of CT and MRI
基金
国家科技支撑计划项目(项目编号:2013BAI07B01)
