摘要
目的探讨CT小肠造影(CTE)对克罗恩病(CD)、肠结核(ITB)的鉴别诊断价值。方法回顾性分析经内镜、病理或临床随访证实的25例CD(CD组)、20例ITB(ITB组)患者的CTE影像表现,并对2组的影像征象差异进行统计学分析。结果 CD组中,多节段跳跃性病灶24例,系膜缘增厚20例,假憩室征8例,分层强化5例,回盲瓣闭塞15例,淋巴结沿肠系膜根部均匀分布23例,肠外表现:"梳状征"23例、肠周脂肪密度增高21例、肠系膜纤维脂肪增生12例,肠外并发症:蜂窝织炎7例、肠外脓肿7例、瘘管7例、肠梗阻8例。ITB组中,肠壁环形对称性增厚18例,回盲瓣挛缩或回盲瓣口固定开放12例,肠系膜淋巴结改变:淋巴结沿右结肠动脉分布为主10例、中心坏死6例,腹膜改变:腹膜、网膜增厚5例、环形强化结节2例。CD组多节段跳跃性病灶、系膜缘增厚、系膜对称性增厚、假性憩室征、分层强化、回盲瓣挛缩或固定开放、回盲瓣闭塞和肠系膜淋巴结为均匀分布、沿右结肠动脉分布为主、中心坏死,腹膜、网膜增厚,环形强化结节、"梳状征"、肠周脂肪密度增高、肠系膜纤维脂肪增生、蜂窝织炎、脓肿、瘘管、肠梗阻所占比例与ITB组比较差异均有统计学意义(均P<0.01)。结论 CTE在CD、ITB的诊断与鉴别诊断中有较高的价值。
Objective To explore the value of CT enteroscopy(CTE)in the differential diagnosis of Crohn’s disease(CD)and intestinal tuberculosis(ITB).Methods The CTE findings of45patients with CD or ITB confirmed by endoscopy,pathology or clinical follow-up were retrospectively analyzed.The imaging signs were compared between CD group(25cases)and ITB group(20cases).Results In CD group,multi-segmental lesions were found in24cases,mesangial margin thickening in 20 cases,false diverticulum in8cases,hierarchical reinforcement in5cases,ileocecal occlusion in15cases,uniform distribution of lymph nodes along the mesenteric root in23cases,parenteral“comb sign”performance in23cases,intestinal fat density increase in21,mesenteric fiber fat hyperplasia in12cases,parenteral cellulitis in7cases,parenteral abscess in7cases,fistula in7cases,and intestinal obstruction in8cases.In ITB group,circular-symmetrical wall thickening was observed in18cases,ileocecal valve contracture or fixation and opening in12cases,mesenteric lymph node distribution along the right colonic artery in10cases,central nodal necrosis in6cases,peritoneal or omental thickening in5cases,and ring-enhancing nodules in2cases.There were significant differences between the two groups in the proportions of multi-segmental lesions,mesangial margin thickening,symmetrical mesangial thickening,false diverticulum,hierarchical reinforcement,ileocecal valve contracture or fixation and opening,ileocecal occlusion,uniform distribution of lymph nodes along the mesenteric root,mesenteric lymph node distribution along the right colonic artery,central necrosis,peritoneal or omental thickening,ring-enhancing nodules,“comb sign”,intestinal fat density increase,mesenteric fiber fat hyperplasia,cellulitis,abscess,fistula,and intestinal obstruction(P<0.01).Conclusion The CTE has a high value in the diagnosis and differential diagnosis of CD and ITB.
作者
万承凤
张萍萍
曾炳亮
WAN Cheng-feng;ZHANG Ping-ping;ZENG Bing-liang(Department of CT,Jiangxi Provincial People’s Hospital,Nanchang330006,China;Department of Radiology,Ji’an Center People’s Hospital,Ji’an343000,China)
出处
《实用临床医学（江西）》
CAS
2018年第10期66-69,共4页
Practical Clinical Medicine
基金
江西省卫计委科技计划项目(20185040)
关键词
克罗恩病
肠结核
体层摄影术
X线计算机
小肠造影术
诊断
鉴别
Crohn's disease
intestinal tuberculosis
tomography,X-ray computed
enterography
diagnosis,differentiation
