Plumb Andrew A, Pendsé Douglas A, McCartney Sara, Punwani Shonit, Halligan Steve, Taylor Stuart A
1 Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, 235 Euston Rd, London, NW1 2BU, United Kingdom.
AJR Am J Roentgenol. 2014 Oct;203(4):W400-7. doi: 10.2214/AJR.13.12055.
OBJECTIVE: The purpose of this article is to describe the MRI findings associated with lymphoid nodular hyperplasia at MR enterography and test the ability of radiologists to differentiate healthy control subjects from patients with Crohn disease (CD). MATERIALS AND METHODS: Ethical approval was granted for this retrospective study. Thirty-five subjects (nine with lymphoid nodular hyperplasia, 13 with CD, and 13 control subjects) who had undergone MR enterography and ileocolonoscopy were identified from the hospital database. Two abdominal radiologists, working in consensus and blinded to diagnosis, scored enteric MR images for T2 signal, contrast enhancement, mural thickness, and diffusion-weighted imaging (DWI) signal and measured the apparent diffusion coefficient (ADC) in all three groups. Scores were compared using the Kruskal-Wallis test. RESULTS: T2 signal and contrast enhancement were judged subjectively to be greater in patients with lymphoid nodular hyperplasia and CD than control subjects (p < 0.001). Mural thickness was greater for patients with lymphoid nodular hyperplasia (median, 6.0 mm) and CD (median, 7.3 mm) than control subjects (median, 2.3 mm) (p < 0.001). Lymphoid nodular hyperplasia and CD increased subjective DWI signal and reduced ADC in comparison with normal control subjects; median ADC was 1.34 × 10(-3) mm(2)/s for lymphoid nodular hyperplasia, 1.36 × 10(-3) mm(2)/s for CD, and 1.86 × 10(-3) mm(2)/s for control subjects (p < 0.001). None of T2 signal, contrast enhancement, wall thickness, DWI signal, or ADC value significantly differed between lymphoid nodular hyperplasia and CD. Lymphoid nodular hyperplasia was erroneously diagnosed as CD in blinded assessment in four of nine cases (44%), whereas all cases of CD and healthy control subjects were correctly classified. CONCLUSION: Lymphoid nodular hyperplasia alters both subjective and quantitative MRI parameters, including T2 signal, contrast enhancement, mural thickness, and ADC. In a subset of patients, lymphoid nodular hyperplasia may be indistinguishable from CD on MR enterography.
目的：本文旨在描述磁共振小肠造影（MR enterography）中与淋巴样结节增生相关的MRI表现，并测试放射科医生区分健康对照者与克罗恩病（CD）患者的能力。 材料与方法：本回顾性研究获得伦理批准。从医院数据库中识别出35名接受过MR小肠造影和回结肠镜检查的受试者（9名患有淋巴样结节增生，13名患有CD，13名对照者）。两名腹部放射科医生在不知诊断结果的情况下达成共识，对肠道MR图像的T2信号、对比增强、肠壁厚度和扩散加权成像（DWI）信号进行评分，并测量所有三组的表观扩散系数（ADC）。使用Kruskal-Wallis检验比较评分。 结果：主观判断淋巴样结节增生和CD患者的T2信号及对比增强高于对照者（p < 0.001）。淋巴样结节增生患者（中位数为6.0 mm）和CD患者（中位数为7.3 mm）的肠壁厚度大于对照者（中位数为2.3 mm）（p < 0.001）。与正常对照者相比，淋巴样结节增生和CD增加了主观DWI信号并降低了ADC；淋巴样结节增生的中位数ADC为1.34×10⁻³ mm²/s，CD为1.36×10⁻³ mm²/s，对照者为1.86×10⁻³ mm²/s（p < 0.001）。淋巴样结节增生和CD之间的T2信号、对比增强、肠壁厚度、DWI信号或ADC值均无显著差异。在盲法评估中，9例淋巴样结节增生患者中有4例（44%）被错误诊断为CD，而所有CD病例和健康对照者均被正确分类。 结论：淋巴样结节增生会改变主观和定量MRI参数，包括T2信号、对比增强、肠壁厚度和ADC。在一部分患者中，淋巴样结节增生在MR小肠造影上可能与CD难以区分。
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