Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Rd, Shanghai, China.
Eur J Radiol. 2012 Jan;81(1):52-9. doi: 10.1016/j.ejrad.2010.11.010. Epub 2010 Dec 23.
The purpose of this study was to determine whether CT enterography (CTE) changes of Crohn's disease (CD) after treatment correlated with clinical remission.
We retrospectively studied 50 known CD patients (male: 35; female: 15) with clinical remission in a period of 3 years (2005-2008). CD was diagnosed by clinical, enteroscopic and pathologic manifestations. Clinical remission was identified by experienced gastroenterologists using the combing criteria of clinical, endoscopy and laboratory tests. First CTE and endoscopy exams were performed during their first hospitalization in our hospital meanwhile CD diagnosis was made during that time. Repeated CTE and endoscopy exams were done after treatment. CTE findings were determined by two experienced radiologists with double-blind approach. Each patient was analyzed for the CTE parameters including bowel wall attenuation, bowel wall thickening (>3mm), bowel wall thickening types (type A: multilayered mural stratification; type B: two layers with strong mucosal enhancement and prominent low-density submucosa; type C: two layers without strong mucosal enhancement; type D: homogeneous enhancement) comb sign, luminal stenosis (mild: luminal diameter 2-3 cm; moderate: luminal diameter 1-2 cm; severe: luminal diameter<1cm) and the presence of extraenteric complications (such as fistulas and abscess). All the quantitative parameters were measured three times by each review.
After treatment, bowel wall thickening was attenuated in 88% of CD patients. Thickness of bowel wall was decreased from 8.8 ± 2.8mm to 6.4 ± 1.9 mm (P<0.001). CT value of bowel wall in portal stage was also declined from 90.0 ± 15.4 (HU) to 73.4 ± 14.2 (HU (P<0.001). The percentage of patients with type A or B bowel wall thickening was decreased from 78.7% to 35.4%, while those with type C or D thickening was increased from 21.2% to 64.6% (P<0.001). The percentage of patients with comb sign was decreased from 88% to 60% (P=0.001). The percentage of patients with moderate or severe luminal stenosis was reduced from 74% to 32% (P<0.001). The ROC (receiver operating characteristic) analysis showed bowel wall attenuation (A(z)=0.89) and bowel wall thickness (A(z)=0.81) were the two best parameters to predict disease activity, and combining of these two values was better than using them solely (κ=0.71, P<0.001). The bowel wall attenuation (OR=9.56, P<0.001) and bowel wall thickness (OR=3.32, P=0.001) were significantly correlated with the disease activity in the following logistic regression analysis.
Therapeutic effect of CD and disease activity can be properly evaluated by CTE.
本研究旨在确定克罗恩病（CD）治疗后 CT 肠造影（CTE）的改变是否与临床缓解相关。
我们回顾性研究了 50 名已知的 CD 患者（男 35 例，女 15 例），他们在 3 年（2005-2008 年）的时间内处于临床缓解期。CD 通过临床、内镜和病理表现进行诊断。临床缓解由经验丰富的胃肠病学家通过结合临床、内镜和实验室检查的标准来确定。首次 CTE 和内镜检查是在这些患者首次住院期间在我院进行的，同时在此期间做出了 CD 诊断。治疗后进行了重复的 CTE 和内镜检查。由两位经验丰富的放射科医生进行 CTE 检查，采用双盲法。每位患者均分析 CTE 参数，包括肠壁衰减、肠壁增厚（>3mm）、肠壁增厚类型（A 型：多层壁分层；B 型：两层黏膜明显强化，伴明显低密度黏膜下层；C 型：两层黏膜强化不明显；D 型：均匀强化）梳征、管腔狭窄（轻度：管腔直径 2-3cm；中度：管腔直径 1-2cm；重度：管腔直径<1cm）和肠外并发症（如瘘管和脓肿）的存在。每次检查均由每位审查员测量三次定量参数。
治疗后，88%的 CD 患者肠壁增厚得到缓解。肠壁厚度从 8.8±2.8mm 减少到 6.4±1.9mm（P<0.001）。门静脉期肠壁 CT 值也从 90.0±15.4（HU）下降到 73.4±14.2（HU）（P<0.001）。A 型或 B 型肠壁增厚的患者比例从 78.7%下降到 35.4%，而 C 型或 D 型增厚的患者比例从 21.2%上升到 64.6%（P<0.001）。梳征患者比例从 88%下降到 60%（P=0.001）。中重度管腔狭窄的患者比例从 74%下降到 32%（P<0.001）。ROC（受试者工作特征）分析显示，肠壁衰减（A（z）=0.89）和肠壁厚度（A（z）=0.81）是预测疾病活动的两个最佳参数，并且联合使用这两个参数优于单独使用（κ=0.71，P<0.001）。肠壁衰减（OR=9.56，P<0.001）和肠壁厚度（OR=3.32，P=0.001）在随后的逻辑回归分析中与疾病活动显著相关。
CTE 可适当评估 CD 的治疗效果和疾病活动度。
