Zhao Xue-Song, Wang Zheng-Ting, Wu Zhi-Yuan, Yin Qi-Hua, Zhong Jie, Miao Fei, Yan Fu-Hua
Departments of *Radiology and †Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Inflamm Bowel Dis. 2014 May;20(5):916-25. doi: 10.1097/MIB.0000000000000025.
Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar clinical, radiological, and endoscopic features. The objective of our study was to investigate the values of clinical features and computed tomographic (CT) enterographic manifestations in the differential diagnosis between CD and ITB.
Clinical features and CT enterographic manifestations in a cohort of 141 patients with CD and 47 patients with ITB were reviewed retrospectively. Parameters were screened by logistic regression analysis. Furthermore, the diagnostic efficacy of screened parameters was analyzed by regression equation (mathematical model) and receiver operating characteristic curve.
The clinical features indicative of CD were hematochezia and perianal disease; features indicative of ITB include positive purified protein derivative skin test, occurrence of ascites, pulmonary tuberculosis, and night sweats. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by clinical features were 94.3, 80.4, 91.0, 93.7, and 82.6%, respectively. CT enterographic manifestations indicative of CD were the involvement of the left colon, asymmetric pattern of involvement and abscess, comb sign; manifestations indicative ITB were the distribution of the lymph nodes along the right colic artery, contracture of ileocecal valve, fixed patulous ileocecal valve and lymph nodes with central necrosis The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by CT enterographic parameters were 96.5, 93.6, 95.7, 97.8, and 89.8%, respectively.
The accuracy of CT enterographic model suggests the possibility of using CT enterography as an alternative to endoscopy in the differentiation between CD and ITB.
克罗恩病（CD）和肠结核（ITB）具有相似的临床、放射学及内镜特征。本研究的目的是探讨临床特征及计算机断层扫描（CT）小肠造影表现在CD和ITB鉴别诊断中的价值。
回顾性分析141例CD患者和47例ITB患者的临床特征及CT小肠造影表现。通过逻辑回归分析筛选参数。此外，采用回归方程（数学模型）和受试者工作特征曲线分析筛选参数的诊断效能。
提示CD的临床特征为便血和肛周病变；提示ITB的特征包括结核菌素皮肤试验阳性、腹水、肺结核及盗汗。由临床特征建立的回归数学模型的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为94.3%、80.4%、91.0%、93.7%及82.6%。提示CD的CT小肠造影表现为左半结肠受累、不对称受累及脓肿、梳征；提示ITB的表现为沿右结肠动脉分布的淋巴结、回盲瓣挛缩、固定开放的回盲瓣及中央坏死的淋巴结。由CT小肠造影参数建立的回归数学模型的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为96.5%、93.6%、95.7%、97.8%及89.8%。
CT小肠造影模型的准确性提示在CD和ITB的鉴别诊断中，CT小肠造影有可能作为内镜检查的替代方法。
