Department of Imaging, Brigham and Women's Hospital, MA 02115, USA.
AJR Am J Roentgenol. 2013 May;200(5):W468-74. doi: 10.2214/AJR.12.9751.
The purpose of this article is to describe the CT findings of ipilimumab-associated colitis.
In this retrospective study, 16 patients diagnosed with ipilimumab-associated colitis and available CT scans obtained at the time of symptoms were found by a search through the electronic medical record database. Two radiologists reviewed the CT images in consensus for the presence of bowel wall thickening, bowel mucosal enhancement, bowel distention, pneumatosis, pericolic fat stranding, and mesenteric vessel engorgement. Medical records were reviewed to note clinical features, management, and outcome.
The common CT findings of ipilimumab-associated colitis were mesenteric vessel engorgement (13/16 [81.3%]) followed by bowel wall thickening (12/16 [75%]) and fluid-filled colonic distention (4/16 [25%]). None of the patients had pneumatosis or halo or target signs. Two distinct CT patterns of ipilimumab-associated colitis were observed: first, the diffuse colitis pattern (n = 12), which is characterized by mesenteric vessel engorgement with mild diffuse bowel wall thickening or fluid-filled distended colon; and, second, the segmental colitis associated with diverticulosis (SCAD) pattern (n = 4), which is characterized by segmental moderate wall thickening and associated pericolic fat stranding in a segment of preexisting diverticulosis. Clinical features and management also differed according to the CT pattern. Patients with the diffuse colitis pattern presented with watery diarrhea and were treated with steroids, whereas the patients with the SCAD pattern presented with mixed watery and bloody diarrhea and cramping pain and were treated with steroids and antibiotics.
Two different radiologic and clinical manifestations of ipilimumab-associated colitis were observed: the diffuse colitis pattern and the SCAD pattern.
本文旨在描述依匹单抗相关性结肠炎的 CT 表现。
在这项回顾性研究中，通过电子病历数据库检索，找到了 16 例经诊断为依匹单抗相关性结肠炎且在症状出现时获得 CT 扫描的患者。两位放射科医生对 CT 图像进行了共识性审查，以评估肠壁增厚、肠黏膜增强、肠腔扩张、气肿、结肠旁脂肪条索和肠系膜血管充血的存在。对病历进行了回顾，以记录临床特征、处理和结果。
依匹单抗相关性结肠炎的常见 CT 表现是肠系膜血管充血（16 例中有 13 例[81.3%]），其次是肠壁增厚（16 例中有 12 例[75%]）和充满液体的结肠扩张（16 例中有 4 例[25%]）。没有患者出现气肿、晕征或靶征。观察到依匹单抗相关性结肠炎的两种不同 CT 表现模式：第一种是弥漫性结肠炎模式（n=12），其特征是肠系膜血管充血伴有轻度弥漫性肠壁增厚或充满液体的扩张结肠；第二种是与憩室病相关的节段性结肠炎（SCAD）模式（n=4），其特征是节段性中度壁增厚和与原有憩室病相关的结肠旁脂肪条索。根据 CT 模式，临床特征和处理也有所不同。弥漫性结肠炎模式的患者表现为水样腹泻，接受了类固醇治疗；而 SCAD 模式的患者表现为混合性水样和血性腹泻、痉挛性腹痛，接受了类固醇和抗生素治疗。
观察到依匹单抗相关性结肠炎的两种不同的放射学和临床表现：弥漫性结肠炎模式和 SCAD 模式。
