Israrahmed Amrin, Yadav Rajanikant R, Yadav Geeta, Helavar Rajesh V, Rai Praveer, Jain Manoj Kumar, Gupta Archna
Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India.
Department of Pathology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India.
JGH Open. 2020 Dec 14;5(2):180-189. doi: 10.1002/jgh3.12478. eCollection 2021 Feb.
Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characterize imaging features on computed tomography enteroclysis/enterography (CTE) that help in differentiating ITB from CD.
A total of 300 consecutive patients who underwent CTE with the suspicion of small bowel diseases were evaluated. CTE findings were documented on a detailed "CTE case record form" and were correlated with other investigations like endoscopy, histopathological and microbiological examination, and improvement on empirical therapy to arrive at a final diagnosis. Only confirmed cases of ITB/CD were included for further analysis.
Final diagnoses revealed that 61 patients had ITB, 24 had CD, 90 patients had a final diagnosis not related to ITB/CD, and 125 had no bowel-related diseases. The sensitivity of CTE (ITB CD, 90.2 91.6%) was higher than the sensitivity of ileocolonoscopy (ITB CD, 87 83.3%). A homogenous pattern of bowel wall thickening and confluent bowel involvement were significantly more common in ITB. Stratified bowel wall thickening with mucosal hyperenhancement, skip lesions in the bowel, and a comb sign were significantly more common in CD. Stratified bowel wall enhancement with an intervening layer of fat was specifically ( < 0.001) seen in patients with CD, and necrotic ( = 0.002) and calcified ( = 0.055) lymph nodes were specifically seen in patients with ITB.
We propose a systematic approach to the radiological differentiation of ITB from CD.
克罗恩病（CD）和肠结核（ITB）在症状表现以及影像学、内镜检查和组织病理学特征方面存在相似之处。区分ITB和CD对于启动正确的医疗管理至关重要。本前瞻性研究旨在描述计算机断层扫描小肠造影/小肠成像（CTE）的影像学特征，以帮助鉴别ITB和CD。
对300例因怀疑小肠疾病而接受CTE检查的连续患者进行评估。CTE检查结果记录在详细的“CTE病例记录表”上，并与内镜检查、组织病理学和微生物学检查等其他检查以及经验性治疗后的改善情况相关联，以得出最终诊断。仅纳入确诊的ITB/CD病例进行进一步分析。
最终诊断显示，61例患者患有ITB，24例患有CD，90例患者的最终诊断与ITB/CD无关，125例无肠道相关疾病。CTE的敏感性（ITB对CD，90.2%对91.6%）高于回结肠镜检查的敏感性（ITB对CD，87%对83.3%）。肠壁增厚均匀及肠管融合受累在ITB中明显更常见。分层肠壁增厚伴黏膜强化、肠道跳跃性病变及梳征在CD中明显更常见。分层肠壁强化伴中间脂肪层在CD患者中特异性出现（<0.001），坏死（=0.002）和钙化（=0.055）淋巴结在ITB患者中特异性出现。
我们提出了一种ITB与CD放射学鉴别的系统方法。
