超声造影定量分析评估克罗恩病炎症活动程度的应用价值

目的探讨超声造影（CEUS）定量分析评估克罗恩病（CD）炎症活动程度的应用价值。 方法回顾性分析2014年2月至8月于中山大学附属第六医院就诊或随访的55例经临床、内镜、病理综合诊断的CD患者。以血清超敏C反应蛋白（hs-CRP）水平为诊断金标准,评价能量多普勒（PDI）Limberg分级、CEUS增强模式及定量分析参数［峰值强度（PI）、上升时间（RT）、达峰时间（TTP）］评估CD炎症活动程度的价值。采用独立样本t检验比较炎症活动期与炎症非活动期CD患者CEUS定量分析参数PI、RT及TTP;以hs-CRP水平作为诊断金标准,分别绘制PDI技术、CEUS增强模式、CEUS定量分析参数PI、RT及TTP诊断CD炎症活动程度的受试者工作特征（ROC）曲线,并采用χ²检验比较曲线下面积。 结果hs-CRP水平显示,本组55例CD患者中,炎症活动期39例,炎症非活动期16例。以hs-CRP水平作为诊断金标准,PDI技术诊断CD炎症活动程度的Youden指数为0.49,CEUS增强模式诊断CD炎症活动程度的Youden指数为0.25;炎症活动期CD患者PI高于炎症非活动期CD患者［（22.7±3.4）dB vs（18.5±3.7）dB］,而炎症活动期CD患者RT及TTP均短于炎症非活动期CD患者［（6.1±1.6）s vs（7.4±3.0）s,（7.5±1.9）s vs（9.3±2.9）s］,且差异均有统计学意义（t=-4.1,P<0.001;t=2.1,P<0.05;t=2.8,P<0.01）;ROC曲线显示,CEUS定量分析参数PI、RT、TTP诊断CD炎症活动期的阈值分别为19 dB、6.2 s、8.7 s,Youden指数分别为0.56、0.39和0.45;PDI技术、CEUS增强模式、CEUS定量分析参数PI、RT、TTP诊断CD炎症活动程度的曲线下面积分别为0.74、0.62、0.82、0.65、0.74。CEUS定量分析参数PI诊断CD炎症活动程度的曲线下面积大于CEUS增强模式诊断CD炎症活动程度的曲线下面积,且差异有统计学意义（P=0.03）,而其余曲线下面积两两比较差异均无统计学意义。 结论CEUS定量分析评估CD炎症活动程度的能力优于CEUS定性分析,与传统PDI Limberg分级方法无显著差异。且CEUS定量分析技术客观可靠,不易受检查者的主观影响,值得临床推广应用。     

CEUS评估克罗恩病活动度的可行性

目的 探讨CEUS评估克罗恩病活动度的可行性。方法 回顾性分析经临床确诊为克罗恩病的39例患者,其中临床疾病活动指数（CDAI）评分<150分（缓解期）18例,150~450分（活动期）21例,分别测量肠壁厚度,对增厚肠壁根据能量多普勒超声表现进行Limberg分型,并分别进行CEUS,对比分析上升时间、峰值强度、平均渡越时间、峰值降半时间、上升斜率及达峰时间的差异。结果 活动期患者的肠壁厚度、峰值强度及上升斜率明显高于缓解期,差异均有统计学意义（P均<0.05）。活动期Limberg Ⅰ型1例,Limberg Ⅱ型4例,Limberg Ⅲ型10例,Limberg Ⅳ型6例;缓解期Limberg Ⅰ型10例,Limberg Ⅱ型7例,Limberg Ⅲ型1例。活动期肠壁血流以Limberg Ⅲ、Ⅳ型为主,缓解期以Ⅰ、Ⅱ型为主,差异有统计学意义（P<0.001）。结论 CEUS可为克罗恩病活动度的评估提供定量资料,具有一定的临床应用价值。     

克罗恩病的超声研究进展

近年来,超声检查已广泛用于克罗恩病(CD)的研究。超声在CD的初步筛查、疾病活动性评估及治疗监测中均发挥重要作用。本文主要对CD的超声研究进展进行综述。     

多普勒超声评价克罗恩病活动性的价值

目的 探讨多普勒超声观察肠系膜上动脉及病变段肠壁内动脉在评估克罗恩病(CD)活动性中的价值。 方法 根据Harvey-Bradshaw指数(HBI)将33例CD患者分为活动组(n=16)和静止组(n=17),采用彩色脉冲多普勒超声定量测量肠系膜上动脉血流,能量多普勒超声对病变段肠壁内血流进行半定量Limberg评分,评价疾病活动性,比较两组间多普勒超声参数,并将其与相应C反应蛋白(CRP)及HBI进行相关分析。 结果 肠系膜上动脉舒张末期流速、阻力指数在活动组与静止组之间的差异有统计学意义(P均<0.05)。两组间病变段肠壁内血流Limberg评分差异有统计学意义(P<0.001)。舒张末期流速与CRP呈正相关(r=0.602,P<0.001),与HBI无显著相关性;阻力指数与CRP(r=－0.676,P<0.001)、HBI(r=－0.415,P=0.020)呈负相关;肠壁血流Limberg分级与CRP(r=0.587,P<0.001)、HBI(r=0.498,P=0.003)相关性较好。 结论 多普勒超声可作为评价CD活动性的可靠工具,指导临床采取合适的治疗措施,对病变随访和疗效监测也具有重要意义。     

CEUS评估克罗恩病的活动性

目的 探讨CEUS在克罗恩病(CD)活动性评估中的应用价值。方法 对经临床确诊为CD的54例患者分别行二维超声、彩色多普勒超声及CEUS检查,观察肠壁厚度、病变处血供情况及病变肠壁血流灌注模式。CD活动性评价参考指标为CD疾病活动指数(CDAI)。结果 CEUS评估CD活动性的敏感度、特异度、准确率分别为95.56%(43/45)、66.67%(6/9)、90.74%(49/54)。CEUS评估CD活动性与CDAI相关性较高(r=0.71,P<0.05),高于二维超声及彩色多普勒超声(r=0.60、0.52,P均<0.05)。结论 CEUS可反映CD的肠壁血流灌注模式,能提示肠壁炎症活动状态,可作为评估CD活动性的一种手段。     

克罗恩病10例分析

目的：分析克罗恩病（Crohn病,CD）的临床表现多样性及误诊的主要原因。方法：对5a收治的10例CD患者的临床表现、内镜及实验室查结果及诊治经过进行分析,分析本病的临床多样性特点及误诊原因。结果：10例患者中,病变侵犯胃肠道任一部位。症状：腹痛、腹泻为主要表现;尚有腹泻与便秘交替、便血。肠外表现多见于发热、贫血、消瘦、皮疹、肾结石、胆石症、口腔溃疡、关节痛。内镜有跳跃式分布的溃疡、息肉、狭窄、或卵石样改变与增殖性病变并存的特点。结论：本病临床表现缺乏特异性,症状多样化,X线检查、内镜联合活检是及时、正确诊断的关键。     

超声造影评估克罗恩病活动性价值的系统评价

目的系统评价超声造影对克罗恩病活动性的诊断价值。方法计算机检索PubMed、EMbase、Cochrane图书馆、中国知网、万方、维普等数据库,收集有关超声造影诊断克罗恩病活动性的诊断性试验,检索时间为建库至2020年1月,由两名研究员筛选文献,提取数据,使用QUADAS-2工具评价纳入研究的偏倚风险,采用Meta Disc 1.4和Stata 12.0软件进行Meta分析。结果共纳入16篇文献的18个研究结果,Meta分析结果显示:超声造影诊断克罗恩病活动性的合并敏感性、特异性、阳性似然比、阴性似然比、诊断比值比及其对应的95%可信区间分别为0.94(0.92～0.96)、0.76(0.71～0.81)、3.30(2.60～4.10)、0.07(0.03～0.18)、64.72(27.87～150.28),曲线下面积为0.92。亚组分析显示:增强曲线的诊断价值最高(曲线下面积为0.95),而存在增强、增强模式、相对增强的曲线下面积分别为0.92、0.93、0.85。结论超声造影可明确判断克罗恩病活动性,特别是在使用增强曲线参数作为阈值时,诊断效能较高。     

克罗恩病活动期常规超声及超声造影特征分析

目的分析克罗恩病活动期常规超声及超声造影特征。方法回顾性分析2011年8月至2012年12月上海市第十人民医院经临床确诊为克罗恩病活动期的20例患者,观察其腹部常规超声及超声造影特征。测量病变段肠壁全层、内侧及外侧肠壁厚度、内外侧肠壁厚度之比;对肠壁能量多普勒超声表现进行Limberg分型;测量肠壁造影剂到达时间、达峰时间、流入时间。不同Limberg分型克罗恩病患者肠壁厚度、造影剂到达时间、达峰时间、流入时间比较应用方差分析,进一步组间两两比较应用LSD．t检验。结果20例克罗恩病患者肠壁全层厚度均大于4mm,为5．5～12．0mm,平均（8．8±0．4）mm;内外侧肠壁厚度之比均大于1。20例克罗恩病患者LimbergII型2例、III型8例、Ⅳ型10例。超声造影主要表现为2种增强模式：13例（13／20,65．0％）表现为内外侧肠壁同时开始的全肠壁增强;7例（7／20,35．0％）表现为从内侧肠壁开始的以内侧肠壁为主的增强。LimbergII型、III型、Ⅳ型克罗恩病患者肠壁全层厚度分别为（6．6±0．1）、（7．5±0．4）、（10．2±0．4）mm,内侧肠壁厚度分别为（3．6±0．6）、（5．0±0．2）、（7．3±0.3）mm,超声造影达峰时间分别为（30．5±2．1）、（26．9±2．4）、（21,0±1．6）S,流入时间分别为（18．0±5．7）、（10．6±1．0）、（8．7±1．2）S。随着Limberg分型增加,克罗恩病患者肠壁全层厚度、内侧肠壁厚度均增加,超声造影达峰时间及流入时间亦增加,且差异均有统计学意义。随着Limberg分型增加,克罗恩病患者内外侧肠壁厚度比也增加,但差异均无统计学意义。不同Limberg分型克罗恩病患者外侧肠壁厚度、肠壁造影剂到达时间差异均无统计学意义。结论克罗恩活动期患者常规超声主要表现为肠壁增厚,能量多普勒Limberg分型增加：超声造影主要表现为肠壁全层均匀增强或以内侧肠壁增强为主：各表现之间有一定关系。     

经腹肠道超声诊断克罗恩病合并肠瘘及肠腔狭窄

目的 观察经腹肠道超声诊断克罗恩病(CD)合并肠瘘及肠腔狭窄的价值。方法 回顾性分析337例CD患者,观察其肠道超声及CT小肠造影(CTE)表现,分析二者诊断CD合并肠瘘的一致性;以手术结果为金标准,评价超声及CTE诊断CD合并肠瘘和肠腔狭窄的效能。结果 337例中,超声及CTE同时诊断CD合并肠瘘48例,诊断一致性极高(Kappa=0.848,P＜0.01)。34例接受手术治疗,其中27例存在肠瘘;超声诊断CD合并肠瘘的敏感度、特异度及准确率分别为92.59%、71.43%及88.24%,CTE诊断的敏感度、特异度及准确率分别为96.30%、71.43%及91.18%,二者差异无统计学意义(McNemar P＞0.05)。27例CD合并肠瘘患者中,18例同时合并肠腔狭窄;超声诊断CD合并肠瘘和肠腔狭窄的敏感度、特异度及准确率分别为88.89%、77.78%及85.19%,CTE诊断的敏感度、特异度及准确率均为88.89%,二者差异无统计学意义(McNemar P＞0.05)。结论 经腹肠道超声诊断CD合并肠瘘和肠腔狭窄效能较高,可媲美CTE。     

简化磁共振活动指数评估克罗恩病活动性

目的 观察简化磁共振活动指数(MaRIAs)评估克罗恩病(CD)活动性的价值.方法 选取79例CD患者,将回结肠分为回肠末段、右半结肠、横结肠、左半结肠及直肠,记录各肠段及总肠段MaRIAs.以CD简化内镜下评分(SES-CD)为金标准,结合粪钙卫蛋白(FC)、红细胞沉降率(ESR)及C反应蛋白(CRP)检测,分析Ma...     

Evaluation of Crohn disease activity with magnetic resonance imaging

Background: The purpose of this study was to assess the accuracy of magnetic resonance imaging (MRI) in evaluating Crohn disease (CD) activity. The intestinal inflammatory activity is usually present in patients under pharmacologic treatment, despite their clinical remission. Methods: Twenty patients with CD, all under pharmacologic treatment, were prospectively studied by MRI at 1.5 T as a periodic control. Positivity of three acute-phase reactants was considered an index of biologic activity (BA). T2-weighted, T2-weighted fat-suppressed turbo spin-echo, and breath-hold T1-weighted turbo field-echo sequences, before and after gadolinium intravenous injection, were obtained. A negative superparamagnetic contrast agent was orally administered. The following MRI parameters were qualitatively evaluated by three radiologists at the level of the affected bowel and compared with clinical data: wall thickness (WT), wall T2-weighted signal (T2W), wall contrast enhancement (WE), amount of fibrofatty proliferation (FP), and T2-weighted signal of fibrofatty proliferation on fat-suppressed images (T2FP). The κ coefficient of agreement was calculated. The Spearman rank correlation was used for the analysis of clinical and radiologic data. Results: Nineteen of 20 patients were in clinical remission (Crohn Disease Activity Index < 150). On the basis of laboratory tests, nine of 20 patients had biologically active disease. An excellent correlation was found between BA and WE, T2W, and T2FP (0.900, 0.927 and 0.961, respectively; p < 0.0001), and a lower correlation was found between BA and WT and between BA and FP (0.78 and 0.62). Excellent statistical correlation was also found between WE and T2W and between WE and T2FP (0.876 and 0.892). Conclusions: An excellent statistical correlation was found between biologically “active” disease and the following MRI parameters: wall gadolinium enhancement, wall hyperintensity on T2-weighted fat-suppressed images, and hyperintensity of fibrofatty proliferation on T2-weighted fat-suppressed images. Therefore, MRI can be valuable in assessing CD activity. Received: 22 January 1999/Revision accepted: 3 November 1999     

Crohn disease activity evaluated by Doppler ultrasonography of the superior mesenteric artery and the affected small-bowel segments.

OBJECTIVE: To reveal the disease activity in Crohn disease by gray scale and Doppler ultrasonography of the superior mesenteric artery (SMA) and the affected bowel segments. METHODS: Twenty-six patients (12 with active and 14 with inactive disease according to the Crohn disease activity index) were prospectively evaluated with gray scale and Doppler ultrasonography. The control group included 10 healthy subjects. In the SMA evaluation, anteroposterior diameter, resistive index (RI), and flow volume were measured. In the affected small-bowel segments, wall thickness, mural vascularity, RI, and extraintestinal findings were evaluated. RESULTS: Differences between the active and inactive groups but not between the inactive and control groups were statistically significant for mean SMA diameter, RI, and flow volume (P = .019; P < .001; and P < .001, respectively). Superior mesenteric artery flow volume values were higher than 500 mL/min in the active group except 2 patients (sensitivity, 83%; specificity, 100%). Increased gut wall thickness and vascularity were highly significant for patients with active disease (P < .001). The mean SMA RI value of the active group was significantly lower (P < .001). Doppler measures of vascularity were similarly affected in the SMA and the bowel wall in the active subgroup. In 10 patients with active disease and higher SMA flow volume (>500 mL/min), the affected small-bowel segments also had increased wall thickness and vascularity. CONCLUSION: Evaluation of the SMA and the affected small-bowel segments together by gray scale and Doppler ultrasonography is a reliable quantitative method for determining Crohn disease activity. Findings obtained from both the SMA and the affected small-bowel segments showed parallel results about the disease activity.     

双能量CT评价克罗恩病活动性的研究进展

克罗恩病是胃肠道慢性炎症性疾病,诊断方法主要有内镜、CT小肠造影、MRI小肠造影以及生化标记物等,但目前仍缺少金标准。双能量CT成像可实现CT检查的多参数成像,并在降低辐射剂量的同时优化图像质量。本文就双能量CT的成像原理以及多参数分析在评价克罗恩病活动性中的应用进行综述。     

Inflammatory activity in Crohn disease: ultrasound findings

Improvements in the ultrasound examination of bowel disease have registered in the last years the introduction of new technologies regarding high frequency probes (US), highly sensitive color or power Doppler units (CD-US), and the development of new non-linear technologies that optimize detection of contrast agents. Contrast-enhanced ultrasound (CE-US) most importantly increases the results in sonographic evaluation of Crohn disease inflammatory activity. CE-US has become an imaging modality routinely employed in the clinical practice for the evaluation of parenchymal organs due to the introduction of new generation microbubble contrast agents which persist in the bloodstream for several minutes after intravenous injection. The availability of high frequency dedicated contrast-specific US techniques provide accurate depiction of small bowel wall perfusion due to the extremely high sensitivity of non-linear signals produced by microbubble insonation. In Crohn’s disease, CE-US may characterize the bowel wall thickness by differentiating fibrosis from edema and may grade the inflammatory disease activity by assessing the presence and distribution of vascularity within the layers of the bowel wall (submucosa alone or the entire bowel wall). Peri-intestinal inflammatory involvement can be also characterized. CE-US can provide prognostic data concerning clinical recurrence of the inflammatory disease and evaluate the efficacy of drugs treatments.