CT 肠造影用于评估回肠结肠型克罗恩病患者的疾病活动度。
CT enterography for evaluation of disease activity in patients with ileocolonic Crohn's disease.
机构信息
Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Shanghai Inflammatory Bowel Disease Research Center, Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
出版信息
BMC Gastroenterol. 2022 Jun 30;22(1):324. doi: 10.1186/s12876-022-02389-5.
BACKGROUND
CT enterography (CTE) is used routinely for assessment of activity and severity in Crohn's disease (CD), but there are few CTE scoring systems. The aim of this study was to develop a quantitative CTE scoring system for ileocolonic Crohn's disease activity.
METHODS
Forty-nine CD patients with ileocolonic involvement were retrospectively included between March 2015 and May 2018. All patients underwent CTE and ileocolonoscopy. Mural hyperenhancement and mural thickening at CTE were scored quantitatively, while mural stratification, submucosal fat deposition, comb sign, perienteric fat hypertrophy and mesenteric fibrofatty proliferation were qualitative variables. A Tobit regression model was applied for assessing the association between Crohn's disease endoscopic index of severity (CDEIS) and CTE variables.
RESULTS
A total of 280 intestinal segments were evaluated. Independent predictors for CDEIS were mural thickness (p < 0.001), mural stratification (p < 0.001) and comb sign (p = 0.002). In order to quantify disease activity based on CTE findings in each segment, a simplified CT enterography index of activity (CTEIA) was derived from logistic regression analysis. The formula was as follows: CTEIA (segment) = 2.1 mural thickness(mm) + 9.7 mural stratification + 5.2 comb sign. There was a high and significant correlation coefficient between CDEIS and CTEIA (r = 0.779, p < 0.001) for per-segment analysis. The model for the detection of ulcerative lesions in the colon and terminal ileum achieved an area under the receiver-operating curve of 0.901 using a cut-off point of 6.25.
CONCLUSIONS
CTEIA is a new qualitative tool for evaluation of ileocolonic Crohn's disease, which need to be validated in further studies.
背景
CT 肠造影（CTE）常用于评估克罗恩病（CD）的活动度和严重程度，但目前尚无 CTE 评分系统。本研究旨在开发一种用于评估回肠结肠 CD 活动度的定量 CTE 评分系统。
方法
回顾性纳入 2015 年 3 月至 2018 年 5 月期间 49 例回肠结肠受累的 CD 患者。所有患者均行 CTE 和回结肠镜检查。在 CTE 上对壁强化和壁增厚进行定量评分，而壁分层、黏膜下脂肪沉积、梳征、肠周脂肪肥大和肠系膜纤维脂肪增生则为定性变量。采用 Tobit 回归模型评估克罗恩病内镜严重程度指数（CDEIS）与 CTE 变量之间的关系。
结果
共评估了 280 个肠段。CDEIS 的独立预测因子为壁厚度（p<0.001）、壁分层（p<0.001）和梳征（p=0.002）。为了根据每个肠段的 CTE 发现量化疾病活动度，我们从逻辑回归分析中得出简化 CT 肠造影活动指数（CTEIA）。公式如下：CTEIA（节段）=2.1 壁厚度（mm）+9.7 壁分层+5.2 梳征。分段分析时，CDEIS 与 CTEIA 之间的相关系数很高且具有统计学意义（r=0.779，p<0.001）。用于检测结肠和末端回肠溃疡性病变的模型，其截断点为 6.25 时，曲线下面积为 0.901。
结论
CTEIA 是一种用于评估回肠结肠 CD 的新的定性工具，需要进一步研究验证。
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