计算机断层扫描肠道成像与小肠镜对小肠克罗恩病检出的一致性

摘要

Objective To evaluate the diagnostic value of computed tomographic enterography (CTE) in the detection of small intestinal Crohn's disease (CD) with balloon-assisted enterography (BAE) as the reference standard.Methods The CTE and BAE data of 81 patients with CD were retrospectively analyzed.The small intestine of CD patients was divided into four segments,such as duodenum,jejunum,proximal ileum and distal ileum.With results of BAE as the reference standard,the sensitivity and specificity of CTE image (bowel wall thickening,mucosa enhancement,comb sign and extraenteric manifestations) in the detection of small intestinal CD were analyzed.Results A total of 182 small bowel segments were included,among which 14 segments were duodenum,17 were jejunum,75 were proximal ileum,and 76 were distal ileum.Among the CTE signs,the sensitivity and specificity of both bowel wall thickening over 3 mm and mucosa enhancement in the detection of small intestinal CD was 82.8％ and 74.2％,respectively.The sensitivity and specificity of bowel wall thickening over 5 mm in the detection of small intestinal CD was 68.1 ％ and 84.8％,respectively.The sensitivity and specificity of comb sign in the detection of small intestinal CD was 67.0％ and 82.1 ％,respectively.The sensitivity and specificity of extraenteric manifestations in the detection of small intestinal CD was 30.2％ and 97.0％,respectively.The sensitivity and specificity of bowel wall thickening over 3 mm in the detection of severe small intestinal inflammation was 89.0％ and 57.8％,respectively.Conclusions CTE has high sensitivity and specificity in detecting small intestinal CD and has good consistency with the results of BAE.CTE has certain reference value in the diagnosis of small intestinal CD.%目的 以气囊辅助式小肠镜(BAE)检查为参考标准,评估CT肠道成像对小肠CD的诊断价值.方法 回顾性分析81例CD患者的CT肠道成像和BAE检查资料.将CD患者的小肠分为十二指肠、空肠、近段回肠和末段回肠4段.以BAE检查结果为参考标准,分析CT肠道成像各征象(肠壁增厚、黏膜强化、梳状征和肠外表现等)对小肠CD检出的敏感度和特异度.结果 共纳入182段小肠肠段,其中十二指肠14段,空肠17段,近段回肠75段,末段回肠76段.CT肠道成像各征象中,肠壁厚度＞3 mm和黏膜强化对小肠CD检出的敏感度均为82.8％,特异度均为74.2％;肠壁厚度＞5 mm对小肠CD检出的敏感度为68.1％,特异度为84.8％;梳状征对小肠CD检出的敏感度为67.0％,特异度为82.1％;肠外表现对小肠CD检出的敏感度为30.2％,特异度为97.0％.肠壁厚度＞3 mm对小肠重度炎性反应检出的敏感度为89.0％,特异度为57.8％.结论 CT肠道成像对小肠CD具有较高的敏感性和特异性,与BAE检查有良好的一致性,对小肠CD的诊断有一定参考价值.