Fanucci A, Cerro P, Cosintino R, Ietto F, Zannoni F
Cattedra di Radiologia Generale e Speciale Odontostomatologica, II Facoltà di Medicina e Chirurgia, Università, Napoli.
Radiol Med. 1992 Jun;83(6):765-9.
One of the major reference points for both prognosis and treatment of ulcerative colitis is the assessment of its extent. Plain abdominal radiographs were performed on 97 patients previously diagnosed, by means of rectoscopy and histobiopsy, as having acute ulcerative colitis. Within the following 36 hours they underwent either full colonoscopy or colectomy. The extent of colitis was evaluated by means of double-blind radiography. The results were then statistically compared with those obtained from endoscopy or from direct study of surgical colonic specimens. There was agreement between the final X-ray results and the actual extent of ulcerative colitis in 78 of 97 patients (80.4%, r = 0.86). The highest agreement was observed in those patients whose lesions were localized in the rectosigma (81%) and in those with fully extended colitis (90%). The most useful radiological findings in predicting the extent of colic lesions were irregular mucosal profile and thickening of colic wall. The presence of these two signs, together with the flattening or swelling of interhaustral folds and the impossible visualization of the right colon, are invariably suggestive of fully extended colitis. On the contrary, no abnormal findings were present on plain abdominal films in 74% of proctosigmoiditis cases. Plain abdominal radiography seems to be useful for the initial evaluation of acute ulcerative colitis. It allows the early discrimination between diffuse and localized forms, and makes it possible to postpone more invasive and dangerous investigations to a remissive phase of the disease.
溃疡性结肠炎预后和治疗的主要参考依据之一是对其病变范围的评估。对97例先前经直肠镜检查和组织活检确诊为急性溃疡性结肠炎的患者进行了腹部平片检查。在接下来的36小时内，他们接受了全结肠镜检查或结肠切除术。通过双盲造影评估结肠炎的范围。然后将结果与通过内镜检查或对手术切除的结肠标本直接研究获得的结果进行统计学比较。97例患者中有78例（80.4%，r = 0.86）的最终X线检查结果与溃疡性结肠炎的实际病变范围相符。病变局限于直肠乙状结肠的患者（81%）和全结肠受累的患者（90%）一致性最高。预测结肠病变范围最有用的放射学表现是黏膜轮廓不规则和结肠壁增厚。这两个征象，再加上肠袋间襞的变平或增厚以及无法显示右半结肠，总是提示全结肠受累的结肠炎。相反，74%的直肠乙状结肠炎病例腹部平片无异常表现。腹部平片似乎有助于急性溃疡性结肠炎的初步评估。它可以早期区分弥漫性和局限性病变，并有可能将更具侵入性和危险性的检查推迟到疾病缓解期进行。
