Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Abdom Radiol (NY). 2017 Feb;42(2):389-395. doi: 10.1007/s00261-016-1032-0.
The purpose of this study is to identify unique imaging findings of refractory celiac disease (RCD) including Type I RCD, Type II RCD versus healed celiac disease (CD).
A retrospective study of patients with known CD and refractory symptoms with cross-sectional imaging was performed. We included patients who underwent T cell receptor rearrangement or T-cell immunophenotyping studies on small bowel (SB) biopsies to classify patients into: healed CD, Type I RCD, or Type II RCD. GI radiologists performed a blinded review of the imaging studies.
One-hundred eighteen patients (32 healed; 67 Type I RCD; 19 Type II RCD) were included (mean age 53 ± 6 years; 62% female). The presence of any fold pattern abnormality was more likely to be found in Type II and Type I RCD than healed CD (53% vs. 43% vs.16%; p = 0.009). Type II RCD patients were more likely than Type I RCD and healed CD to have imaging findings of ulcerative jejunitis (26% vs. 6% vs. 3%; p = 0.009), SB wall thickening (37% vs. 16% vs. 0%; p = 0.002) and SB dilation (26% vs. 7% vs. 6%; p = 0.04). Type II RCD demonstrated non-significant trends for decreased number of jejunal folds only, SB mass, mesenteric lymphadenopathy, localized peri-mural edema, and intramural duodenal edema.
Fold pattern abnormalities, ulcerative jejunitis, SB wall thickening, and SB dilation are more likely to be identified in cross-sectional imaging of RCD than healed CD. SB dilatation and ulcerative jejunitis are more likely to be found in Type II than Type I RCD.
本研究旨在确定难治性乳糜泻（RCD）的独特影像学表现，包括 RCD I 型、RCD II 型与治愈的乳糜泻（CD）之间的区别。
对经影像学检查的已知 CD 且伴有难治性症状的患者进行回顾性研究。我们纳入了接受小肠（SB）活检的 T 细胞受体重排或 T 细胞免疫表型研究的患者，以便将患者分类为：治愈 CD、RCD I 型或 RCD II 型。胃肠放射科医生对影像学研究进行了盲法审查。
共纳入 118 例患者（32 例治愈；67 例 RCD I 型；19 例 RCD II 型）（平均年龄 53±6 岁；62%为女性）。与治愈 CD 相比，RCD II 型和 RCD I 型更有可能出现任何折叠模式异常（53%比 43%比 16%；p=0.009）。与 RCD I 型和治愈 CD 相比，RCD II 型患者更有可能出现溃疡性空肠炎的影像学表现（26%比 6%比 3%；p=0.009）、SB 壁增厚（37%比 16%比 0%；p=0.002）和 SB 扩张（26%比 7%比 6%；p=0.04）。RCD II 型仅表现为 jejunal 褶皱数量减少、SB 肿块、肠系膜淋巴结病、局部壁层周围水肿和壁内十二指肠水肿的非显著趋势。
与治愈 CD 相比，RCD 的横断面成像更有可能出现折叠模式异常、溃疡性空肠炎、SB 壁增厚和 SB 扩张。与 RCD I 型相比，RCD II 型更有可能出现 SB 扩张和溃疡性空肠炎。
