Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2022 Jul;63(7):675-682. doi: 10.3349/ymj.2022.63.7.675.
To identify initial abdominal computed tomography (CT) and laboratory findings prior to a diagnosis of Crohn's disease (CD) in children.
In this retrospective study, patients (≤18 year-old) who were diagnosed with CD from 2004 to 2019 and had abdominal CT just prior to being diagnosed with CD were included in the CD group. Patients (≤18 years old) who were diagnosed with infectious enterocolitis from 2018 to 2019 and had undergone CT prior to being diagnosed with enterocolitis were included as a control group. We assessed the diagnostic performances of initial CT and laboratory findings for the diagnosis of CD using logistic regression and the area under the curve (AUC).
In total, 107 patients (50 CD patients, 57 control patients) were included, without an age difference between groups (median 13 years old vs. 11 years old, =0.119). On univariate logistic regression analysis, multisegmental bowel involvement, mesenteric vessel engorgement, higher portal vein/aorta diameter ratio, longer liver longitudinal diameter, lower hemoglobin (≤12.5 g/dL), lower albumin (≤4 g/dL), and higher platelet (>320×10/µL) levels were significant factors for CD. On multivariate analysis, multisegmental bowel involvement [odds ratio (OR) 111.6, 95% confidence interval (CI) 4.778-2605.925] and lower albumin levels (OR 0.9, 95% CI 0.891-0.993) were significant factors. When these two features were combined, the AUC value was 0.985 with a sensitivity of 96% and specificity of 100% for differentiating CD.
Multisegmental bowel involvement on CT and decreased albumin levels can help differentiate CD from infectious enterocolitis in children prior to a definite diagnosis of CD.
确定儿童克罗恩病（CD）诊断前的初始腹部计算机断层扫描（CT）和实验室检查结果。
在这项回顾性研究中，纳入了 2004 年至 2019 年间被诊断为 CD 且在被诊断为 CD 之前进行了腹部 CT 的患者（≤18 岁）作为 CD 组。纳入了 2018 年至 2019 年间被诊断为感染性肠炎且在被诊断为肠炎之前进行了 CT 的患者（≤18 岁）作为对照组。我们使用逻辑回归和曲线下面积（AUC）评估初始 CT 和实验室检查结果对 CD 诊断的诊断性能。
共纳入 107 例患者（50 例 CD 患者，57 例对照组患者），两组之间无年龄差异（中位数分别为 13 岁和 11 岁，=0.119）。单变量逻辑回归分析显示，多节段肠受累、肠系膜血管充血、门静脉/主动脉直径比升高、肝长径延长、血红蛋白水平≤12.5g/dL、白蛋白水平≤4g/dL、血小板水平>320×10/µL 是 CD 的显著因素。多变量分析显示，多节段肠受累（比值比 111.6，95%置信区间 4.778-2605.925）和白蛋白水平降低（比值比 0.9，95%置信区间 0.891-0.993）是显著因素。当这两个特征结合时，AUC 值为 0.985，对 CD 的诊断具有 96%的敏感性和 100%的特异性。
CT 上的多节段肠受累和白蛋白水平降低有助于在明确诊断 CD 之前区分儿童的 CD 与感染性肠炎。
