摘要
目的探讨小肠CT成像(computed tomography enterography, CTE)淋巴结特征对肠结核(intestinal tuberculosis, ITB)及Crohn病(Crohn disease, CD)的鉴别诊断价值。方法对行CTE检查并符合纳入及排除标准的ITB及CD共98例的临床特征和CTE征象进行分析,采用多因素Logistic回归分析和受试者工作特征(ROC)曲线对CTE淋巴结特征对肠结核及Crohn病鉴别诊断价值进行分析。结果本研究共纳入26例ITB及72例CD。腹腔积液、肺结核、人类免疫缺陷病毒(HIV)感染及结核菌素纯蛋白衍生物(PPD)试验阳性率ITB患者高于CD患者,而腹泻率CD患者高于ITB患者,差异有统计学意义(P<0.05或P<0.01)。十二指肠及空肠、近段回肠、直肠以及肛周受累率CD患者高于ITB患者,差异有统计学意义(P<0.05或P<0.01)。CD患者CTE多节段病变、肠壁偏心性增厚、腹腔脓肿或肠瘘及梳状征率高于ITB患者,ITB患者CTE淋巴结短径、淋巴结环形强化率及淋巴结沿右结肠动脉分布率长于或高于CD患者,差异有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析结果显示,CTE淋巴结环形强化对ITB及CD鉴别诊断价值显著。ROC曲线分析结果显示,当淋巴结短径为7.9 mm时,鉴别CD及ITB的敏感性及特异性分别为96.2%和69.4%,ROC曲线下面积为0.931。结论 CTE淋巴结大小和环形强化对ITB及CD鉴别诊断价值显著,在临床工作中注意CTE淋巴结特征有望减少二者相互误诊。
Objective To explore the value of lymph nodes features on CT enterography(CTE) in differential diagnosis between intestinal tuberculosis(ITB) and Crohn’s disease(CD). Methods The clinical characteristics and CTE signs of 98 cases of ITB or CD who underwent CTE examination and met the inclusion and exclusion criteria were analyzed. Multivariate logistic regression analysis and receiver operating characteristic(ROC) curves were used to analyze the value of lymph nodes features on CTE in differential diagnosis of ITB and CD. Results A total of 26 patients with ITB and 72 patients with CD were included in this study. The rate of ascites, pulmonary tuberculosis, human immunodeficiency virus(HIV) infection and positive tuberculin purified protein derivative(PPD) skin test were significantly higher in ITB patients than in CD patients, while diarrhea rate was significantly higher in CD patients than in ITB patients(P<0.05 or P<0.01). The rate of duodenum and jejunum, proximal ileum, rectum and perianal involvement were significantly higher in CD patients than in ITB patients(P<0.05 or P<0.01). The patients with CD had a significantly higher occurrence of multisegmental lesions, asymmetrical mural thickening, intestinal abscess or fistula, and comb sign on CTE than ITB patients. whereas the short diameter of the lymph nodes, the rate of annular enhancement and distribution of lymph nodes along the right colonic artery on CTE were significantly longer or higher in ITB patients than in CD patients(P<0.05 or P<0.01). Multivariate logistic regression analysis showed that annular enhancement of lymph nodes was significantly valuable for the differential diagnosis of ITB and CD. The results of ROC curve analysis showed that when the short diameter of lymph nodes was 7.9 mm, the sensitivity and specificity in distinguishing CD and ITB were 96.2% and 69.4% respectively, and the area under the ROC curve was 0.931. Conclusion Lymph node size and annular enhancement sign on CTE are of significant value for the differential diagnos
作者
吴慧
程静云
徐国斌
王艳
冷小园
吴光耀
WU Hui;CHENG Jing-yun;XU Guo-bin;WANG Yan;LENG Xiao-yuan;WU Guang-yao(Department of Radiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)
出处
《临床误诊误治》
2020年第2期61-66,共6页
Clinical Misdiagnosis & Mistherapy
基金
国家自然科学基金重大仪器专项(81171315)
国家重点研发专项(2016YFC1304702)
关键词
结核
肠
CROHN病
小肠CT成像
淋巴结
诊断
鉴别
Tuberculosis
Intestines
Crohn disease
Computed tomography enterography
Lymph nodes
Diagnosis,differential
