CT小肠造影及能谱成像诊断克罗恩病活动期的效能

目的 探讨CT小肠造影（CTE）和能谱成像对活动期与缓解期克罗恩病（CD）的诊断效能。方法 收集经临床确诊并接受CTE检查的54例CD患者,其中38例接受能谱成像,根据CD活动性指数（CDAI）将其分为活动期和缓解期,观察并比较活动期和缓解期患者CTE影像学特征和能谱曲线斜率,根据病变肠壁厚度、累及肠段数量、"靶征"、"梳齿征"、肠系膜增大淋巴结、肠腔狭窄后扩张以及脓肿或瘘道7个影像学征象,对患者进行CTE综合评分,以ROC曲线评价能谱曲线斜率和CTE综合评分诊断活动期与缓解期CD的效能。结果 活动期CD患者中,肠腔狭窄后扩张、"靶征"、"梳齿征"、肠系膜淋巴结增大的出现比例高于缓解期（P均<0.05）;"假憩室征"、均匀一致强化在缓解期出现比例高于活动期（P均<0.05）。CD活动期平扫、动脉期、门静脉期能谱曲线斜率分别为1.48±0.49、4.33±1.39、5.55±1.15,缓解期斜率分别为1.29±0.32、3.15±0.46、3.82±0.68,活动期和缓解期平扫斜率差异无统计学意义（P=0.182）,动脉期和门静脉期斜率活动期均高于缓解期（P均<0.05）。动脉期、门静脉期斜率和CTE综合评分诊断活动期与缓解期CD的ROC曲线的AUC分别为0.83、0.87和0.93,敏感度为81.8%、77.3%和87.5%,特异度为62.5%、81.3%和81.8%。结论 CTE综合评分和CT能谱成像对活动期与缓解期CD具有较高的诊断效能。

Efficacy of CT enterography and energy spectrum imaging in evaluation on activity of Crohn's disease

Objective To explore the diagnostic efficacy of CT enterography (CTE) and energy spectrum imaging in evaluation on the activity and remission periods of Crohn''s disease (CD). Methods Totally 54 patients with clinically diagnosed CD underwent CTE examination, among them 38 underwent spectrum imaging. The patients were divided into active and remission period based on CD activity index (CDAI). CTE characteristics and spectral curve slopes were compared between active and remission period. Based on 7 basic imaging signs, such as intestinal wall thickness, lesions involving the bowel, "target sign", "comb sign", mesenteric lymph nodes enlargement, narrow lumen expansion and abscess or fistula, CTE score of each patient was calculated. ROC curve was used to evaluate the efficacy of slope of the energy spectrum and CTE scores in diagnosis of activity and remission periods of CD. Results In the active period, there was a higher incidence of narrow lumen expansion, "target sign", "comb sign" and mesenteric lymph node enlargement than those in the remission period (all P<0.05). The incidence of "false diverticulum sign", uniform enhancement in the remission period was higher than those in the active period (both P<0.05). The spectrum curve slopes of the plain scan, arterial and portal venous phases were 1.48±0.49, 4.33±1.39 and 5.55±1.15 in active group, 1.29±0.32, 3.15±0.46 and 3.82±0.68 in remission period. No significant difference of spectrum curve slope of plain scan was found between the active and remission period (P=0.182), while the slopes of the arterial and portal venous phases in active period were higher than those in remission period (both P<0.05). AUC of ROC curve of arterial and portal venous phase slope and CTE scores in evaluation on activity and remission CD was 0.83, 0.87 and 0.93, the sensitivity of 81.8%, 77.3% and 87.5%, and the specificity of 62.5%, 81.3% and 81.8%, respectively. Conclusion CTE scores and CT energy spectrum imaging have high diagnostic efficacy in judging active and remission CD.