摘要
目的基于CT肠道成像(CTE)创建肠系膜爬行脂肪指数(MCFI)以描述爬行脂肪缠绕克罗恩病(CD)炎性肠道的范围,并评估MCFI与CD炎症性肠道狭窄的相关性。方法前瞻性连续收集2018年12月至2019年7月于中山大学附属第一医院行手术治疗的CD患者,基于CTE容积数据重建肠系膜小血管缠绕狭窄肠道的范围以构建MCFI;通过测量肠道最狭窄处管径和狭窄近端肠管管径获取肠道狭窄指数。采用CTE和手术标本区域-区域定位的方法,评估标本上爬行脂肪缠绕狭窄肠道的范围获取肠道标本爬行脂肪评分,剪取肠壁组织行HE染色以获取炎症评分。采用Spearman相关分析评价MCFI、肠道标本爬行脂肪评分与炎症评分、肠道狭窄指数之间相关性;采用ROC曲线分析评估MCFI区分中重度和轻度炎症肠壁的准确性。结果共纳入30例CD患者。肠道标本爬行脂肪评分与炎症评分呈中等正相关(r_(s)=0.403,P=0.027),与肠道狭窄指数呈较强的正相关(r_(s)=0.642,P<0.001)。MCFI与肠道标本爬行脂肪评分呈强相关(r_(s)=0.840,P<0.001),与炎症评分呈中等正相关(r_(s)=0.497,P=0.005),与肠道狭窄指数呈较强的正相关(r_(s)=0.599,P<0.001)。ROC曲线分析显示MCFI区别中重度与轻度炎症肠壁的曲线下面积为0.718(95%CI 0.522~0.913)。当MCFI≥4分时,诊断病变肠壁为中重度炎症的灵敏度为81.8%,特异度为47.4%。结论爬行脂肪与CD炎症性肠道狭窄具有相关性,MCFI可无创性描述爬行脂肪缠绕CD肠道的范围,从而评估CD炎症性肠道狭窄。
Objective To develop a mesenteric creeping fat index(MCFI)based on CT enterography(CTE)to characterize the degree of creeping fat wrapping around the inflamed gut in Crohn disease(CD),and to assess the relationship between MCFI and the inflammatory intestinal stricture.Methods From December 2018 to July 2019,the patients with CD who underwent surgery in the Fir_(s)t Affiliated Hospital of Sun Yat-Sen Univer_(s)ity were prospectively collected.The extent of perienteric mesenteric vessels wrapping around the gut was reconstructed to develop MCFI based on CTE images.The intestinal stricture index was obtained by calculating the ratio of the maximal upstream luminal diameter divided by the minimum luminal diameter apparent within the stricturing region.Using region-by-region correlation between CTE and surgical specimen,creeping fat score in intestinal specimen was obtained by assessing the extent of creeping fat wrapping around the resected bowel segment,and HE staining was performed on the bowel specimen corresponding to creeping fat to obtain the pathological inflammatory score.The Spearman correlation analysis was used to evaluate the correlation between MCFI,creeping fat score in intestinal specimen,and inflammatory score,intestinal stricture index.The ROC curve analysis was used to assess the accuracy of MCFI in distinguishing moderate-severe and mild inflammatory bowel walls.Results Totally 30 CD patients were enrolled.The creeping fat score in intestinal specimen positively correlated with pathological inflammatory score(r_(s)=0.403,P=0.027)and with intestinal stricture index(r_(s)=0.642,P<0.001).MCFI positively correlated with creeping fat score in intestinal specimen(r_(s)=0.840,P<0.001),with pathological inflammatory score(r_(s)=0.497,P=0.005),and with intestinal stricture index(r_(s)=0.599,P<0.001).ROC analysis showed that the area under the curve of MCFI for differentiating moderate-severely from mildly inflammatory bowel walls was 0.718(95%CI 0.522-0.913).Using MCFI≥4 as a cutoff value,the sensitivity
作者
侍丽
黄丽
卢宝兰
黄斯韵
杜金芳
林锦江
冯仕庭
孙灿辉
李子平
李雪华
Shi Li;Huang Li;Lu Baolan;Huang Siyun;Du Jinfang;Lin Jinjiang;Feng Shiting;Sun Canhui;Li Ziping;Li Xuehua(Department of Radiology,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2021年第8期847-852,共6页
Chinese Journal of Radiology
基金
国家自然科学基金(81870451,81600508,81770654,81971684,81771908)。
