Park Eun Kyung, Han Na Yeon, Park Beom Jin, Sung Deuk Jae, Cho Sung Beom, Jeen Yoon Tae, Keum Bora, Kim Min Ju
Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Iran J Radiol. 2016 Jun 21;13(4):e34301. doi: 10.5812/iranjradiol.34301. eCollection 2016 Oct.
The accurate evaluation of Crohn's disease activity is important for the treatment of the disease and for monitoring the response. Computerized tomography (CT) enterography is a useful imaging modality that reflects enteric inflammation, as well as extramural complications.
The aim of this study was to evaluate the correlation between CT enterographic (CTE) findings of active Crohn's disease and the Crohn's disease activity index (CDAI) and C-reactive protein (CRP).
Fifty CT enterographies of 39 patients with Crohn's disease in the small bowel were used in our study. The CDAI was assessed through clinical and laboratory variables. Multiple CT parameters, including mural hyperenhancement, mural thickness, mural stratification, comb sign, and mesenteric fat attenuation, were evaluated with a four-point scale. The presence or absence of enhanced lymph nodes, fibrofatty proliferation, sinus or fistula, abscess, and stricture were also assessed. Two gastrointestinal radiologists independently reviewed all CT images, and inter-observer agreement was examined. Correlations between CT findings, CRP, and CDAI were assessed using Spearman's rank correlation and logistic regression analysis. To assess the predictive accuracy of the model, a receiver-operating characteristic curve analysis for the sum of CT enterographic scores was used.
Mural hyperenhancement, mural thickness, comb sign, mesenteric fat density, and fibrofatty proliferation were significantly correlated with CDAI and CRP (P < 0.05). The binary logistic regression model demonstrated that mesenteric fat density, mural stratification, and the presence of enhanced lymph nodes (P < 0.05) had an influence on CDAI severity. The area under the receiver operating characteristic curve (AUROC) of the CTE index for predicting disease activity was 0.85. Using a cut-off value of 8, the sensitivity and negative predictive values were 95% and 94%, respectively.
Most CTE findings correlated with CDAI and CRP in patients with active Crohn's disease.
准确评估克罗恩病的活动度对于疾病治疗及监测治疗反应十分重要。计算机断层扫描（CT）小肠造影是一种有用的影像学检查方法，可反映肠道炎症及肠壁外并发症。
本研究旨在评估活动期克罗恩病的CT小肠造影（CTE）表现与克罗恩病活动指数（CDAI）及C反应蛋白（CRP）之间的相关性。
本研究使用了39例小肠克罗恩病患者的50次CT小肠造影检查结果。通过临床及实验室指标评估CDAI。采用四点量表评估多个CT参数，包括肠壁强化、肠壁厚度、肠壁分层、梳征及肠系膜脂肪衰减。同时评估强化淋巴结、纤维脂肪增生、窦道或瘘管、脓肿及狭窄的有无。两名胃肠放射科医生独立阅片，并检查观察者间的一致性。采用Spearman秩相关分析及逻辑回归分析评估CT表现、CRP及CDAI之间的相关性。为评估模型的预测准确性，对CT小肠造影评分总和进行受试者工作特征曲线分析。
肠壁强化、肠壁厚度、梳征、肠系膜脂肪密度及纤维脂肪增生与CDAI及CRP显著相关（P < 0.05）。二元逻辑回归模型显示，肠系膜脂肪密度、肠壁分层及强化淋巴结的存在（P < 0.05）对CDAI严重程度有影响。CTE指数预测疾病活动度的受试者工作特征曲线下面积（AUROC）为0.85。采用截断值8时，敏感性及阴性预测值分别为95%和94%。
在活动期克罗恩病患者中，多数CTE表现与CDAI及CRP相关。
