Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
Can Assoc Radiol J. 2014 Feb;65(1):67-70. doi: 10.1016/j.carj.2012.01.002. Epub 2012 Nov 9.
BACKGROUND: Bowel-wall thickening (BWT) is a commonly reported finding on diagnostic abdominal pelvic computed tomographies (CT) in patients with no history of gastroenterologic disease. The significance of this nonspecific finding is not clear. METHODS: Medical records from the Vancouver General Hospital were reviewed from October 27, 1999, to October 27, 2009. The initial search yielded 5696 cases, of which 76 cases met the inclusion criteria for review. Inclusion criteria were the following: age older than 18 years, symptoms without a diagnosis of gastrointestinal disease before CT, the reported finding of terminal ileal and/or colonic BWT, colonoscopy after CT, and/or microbiologic investigations. Exclusion criteria included known gastrointestinal disease before CT. The primary objective was to determine if BWT could be associated with a significant endoscopic pathology. The secondary objective was to determine whether the pattern of abnormality on the CT was associated with a specific endoscopic finding. RESULTS: A total of 76 patients met the inclusion criteria of our study. Of those, 76% had various identifiable pathologies on colonoscopy. Only 24% had normal colonoscopic findings. Inflammatory bowel disease (IBD) and infectious colitis were the most common causes of BWT. A report of "skip lesions" on the CT (5%) was always associated with IBD. "Pancolitis" reported on the CT (11%) was associated with endoscopic findings of IBD in 25% of cases, infection in 50% of cases, and normal findings in 25% of cases. The report of "stranding" (36%) on CT in the presence of BWT was associated with many non-neoplastic endoscopic pathologic processes, including infectious colitis (22%), IBD (19%), and ischemia (15%), but also was associated with normal endoscopic findings in 26% of the cases. "Lymphadenopathy" was reported in 17% of the CTs and was associated with infectious colitis (30%), IBD (38%), or neoplastic processes (15%) but also normal endoscopic findings in 15%. CONCLUSION: Symptomatic patients who are found to have nonspecific BWT on CT should undergo definitive endoscopic investigation because the majority will have significant gastroenterologic disease, and only a minority will have a normal colonoscopy.
背景：肠壁增厚（BWT）是在无胃肠道疾病史的患者中进行诊断性腹部盆腔 CT 检查时经常报告的发现。这种非特异性发现的意义尚不清楚。
方法：回顾 1999 年 10 月 27 日至 2009 年 10 月 27 日期间温哥华综合医院的病历。最初的搜索结果为 5696 例，其中 76 例符合审查纳入标准。纳入标准为：年龄大于 18 岁，CT 前无胃肠道疾病症状，报告末端回肠和/或结肠 BWT，CT 后行结肠镜检查和/或微生物学检查。排除标准包括 CT 前已知胃肠道疾病。主要目的是确定 BWT 是否与明显的内镜病理学相关。次要目的是确定 CT 上的异常模式是否与特定的内镜发现相关。
结果：共有 76 例患者符合我们研究的纳入标准。其中，76%的患者在结肠镜检查中有各种可识别的病变。只有 24%的患者结肠镜检查结果正常。炎症性肠病（IBD）和感染性结肠炎是 BWT 的最常见原因。CT 上报告的“跳跃性病变”（5%）总是与 IBD 相关。CT 报告的“全结肠炎”（11%）在 25%的病例中与 IBD 的内镜发现相关，在 50%的病例中与感染相关，在 25%的病例中与正常发现相关。在存在 BWT 的情况下，CT 上报告的“成束状”（36%）与许多非肿瘤性内镜病理过程相关，包括感染性结肠炎（22%）、IBD（19%）和缺血性结肠炎（15%），但也有 26%的病例与正常的内镜发现相关。CT 报告的“淋巴结病”（17%）与感染性结肠炎（30%）、IBD（38%）或肿瘤过程（15%）相关，但也有 15%的病例与正常的结肠镜检查结果相关。
结论：在 CT 上发现非特异性 BWT 的有症状患者应进行明确的内镜检查，因为大多数患者将患有严重的胃肠道疾病，只有少数患者的结肠镜检查结果正常。
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