X线、CT和MRI对小肠Crohn病诊断价值的评价

目的:探讨X线、CT和MRI对小肠Crohn病的诊断价值及其限度.材料和方法:分析经肠镜、手术和病理诊断的26例小肠Crohn病的X线、CT和MRI表现,其中X线小肠灌肠13例,CT小肠造影15例,MRI检查13例(其中小肠MRI水成像和注气小肠灌肠分别为7例和6例),同时行X线小肠灌肠和CT检查7例,行X线小肠灌肠和MRI检查8例,行CT和MRI检查2例.结果:13例小肠Crohn病的X线表现为多个节段性病变12例(92%),线形溃疡11例(85%),卵石征11例(85%),瘘管形成4例,不对称性病变伴假憩室样改变3例,误诊为肠管外炎性肿块和脓肿3例.15例CT小肠造影表现为肠壁增厚15例(100%),强化增加13例(87%),多节段性病变13例(87%),肠管周围蜂窝织炎11例(73%),脓肿和炎性肿块5例,瘘管形成3例.13例MRI表现为肠壁强化增加13例(100%),肠壁增厚12例(92%),多节段性病变11例(85%),肠管周围蜂窝织炎9例(69%),炎性肿块6例,瘘管2例.CT和MRI均未显示肠壁线形溃疡和卵石征.结论:X线小肠灌肠易于显示小肠Crohn病线形溃疡和卵石征的特征性改变,对小肠Crohn病的初次诊断具有重要价值,但难以明确显示肠管外炎性肿块和脓肿;CT和MRI均难以显示肠壁线形溃疡和卵石征,但可明确显示病变肠壁及其周围并发症,对于指导临床治疗以及评价临床疗效具有重要价值.

Assessment of the Diagnostic Value of X-ray, CT and MRI for Crohn Disease of the Small Bowel

To investigate the value and limits of X - ray, CT and MRI in the diagnosis of small intestinal Crohn' s disease.Materials and Methods: The X - ray, CT and MRI findings of 26 cases of small intestinal Crohn's disease diagnosed by endoscopy, surgery and pathology were analyzed, in which 13 cases were examined with conventional enteroclysis, 15 cases with CT enterography and 13 cases with MRI. (In which 7cases and 6 cases received small intestinal hydro - MRI and air - infused MR enteroclysis, respectively) . In addition, 7 cases received both enteroclysis and CT enterography, 8 cases received both enteroclysis and MRI, and 2 cases received both CT and MRI.Results: Among the 13 cases of enteroclysis, there were 12 cases(92%) of skip lesions, 11 cases(85%) of strip ucers, 11 cases(85%) of cobblestones , 4 cases of fistulas, 3 cases of asymmetric lesions with pseudo - diverticular change and 3 cases of misdiagnosed abscesses or inflammatory masses. Among the 15 cases of CT enterography, there were 15 cases(100%) of mural thickening, 13 cases(87%) of increased enhancement of bowel wall, 13 cases (87%) of skip lesions, 11(73%) cases of phlegmon, 5cases(33%) of abscesses and inflammatory masses and 3 cases of fistulas. Among the 13 cases of MRI, there were 13 cases (100%) of increased enhancement of bowel wall, 12 cases(92%) of mural thickening, 11 cases(85%) of skip lesions, 9(69%) cases of phlegmon, 6 cases of inflammatory masses, 2 cases of fistulas. Both CT enterography and MRI couldnot demonstrated the change of mucosa such as strip ucers and cobblestones. Conclusion: Enteroclysis is easy to demonstrate the characteristic changes of small intestinal Crohn' s disease such as strip ucers and cobblestones, which is of important value to the first diagnosis of small intestinal Crohn' s disease, but it is difficult to demonstrate the extraintestinal inflammatory mass and abscesse. Both CT and MRI cannot demonstrate strip ucers and cobblestones of bowel wall, but they can demonstrate exactly the diseased bowel wall and extraintestinal complication of Crohn' s disease , which is of important value to guide clinic treatment and to assess the effect of treatment.