Jehangir Majid, Parry Arshed H, Wani Suhail H, Kadla Showket, Sheikh Bilal
Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu & Kashmir, India.
Department of Gastroenterology, Government Medical College, Srinagar, Jammu & Kashmir, India.
Pol J Radiol. 2023 Dec 4;88:e553-e561. doi: 10.5114/pjr.2023.133673. eCollection 2023.
Ileocolonoscopy aids in the diagnosis of ileocecal region pathologies when typical mucosal lesions are seen. However, in many cases the mucosal lesions of the ileocaecal region are atypical, rendering themselves to diagnostic dilemma. The present study aimed to study the role of computed tomography (CT) enterography in the evaluation of symptomatic patients who demonstrated ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy.
Symptomatic patients who had ileocolonoscopy documented ileocecal mucosal lesions of uncertain diagnosis were enrolled. Patients were subjected to CT enterography within 10 days of ileocolonoscopy. On CT enterography a diagnosis of Crohn's disease (CD) or ileocaecal tuberculosis (ITB) was made. The diagnosis obtained by CT enterography was correlated with the final diagnosis obtained from histopathology. Using descriptive statistics, the diagnostic performance of CT enterography was evaluated.
A total of 153 cases were enrolled in the study. CT enterography findings were present in 147 cases, resulting in a diagnostic yield of 96%. Out of these, 58.16% (89/153) had CD, 26.14% (40/153) had ITB, 6.5% (10/153) had infectious ileitis, and 9.15% (14/153) were indeterminate on histopathology. CT enterography correctly identified 78.65% (70/89) of CD and 75% (30/40) of ITB. CT enterography had a sensitivity of 78.65% and 75%, specificity of 67.19% and 87.61%, positive predictive value of 76.92% and 68.18%, and diagnostic accuracy of 73.86% and 84.31% for diagnosing CD and ITB, respectively.
CT enterography provided a high diagnostic yield in ileocaecal mucosal lesions of uncertain significance on endoscopy. CD and ITB were the predominant diseases detected in these individuals. CT enterography had a good diagnostic performance in the detection of these 2 disorders.
当见到典型黏膜病变时，回结肠镜检查有助于诊断回盲部病变。然而，在许多情况下，回盲部的黏膜病变并不典型，从而导致诊断困境。本研究旨在探讨计算机断层扫描（CT）小肠造影在评估经回结肠镜检查显示回盲部黏膜病变但诊断不明确的有症状患者中的作用。
纳入经回结肠镜检查记录有诊断不明确的回盲部黏膜病变的有症状患者。患者在回结肠镜检查后10天内接受CT小肠造影检查。根据CT小肠造影结果诊断克罗恩病（CD）或回盲部结核（ITB）。将CT小肠造影获得的诊断结果与组织病理学最终诊断结果进行对比。采用描述性统计方法评估CT小肠造影的诊断性能。
本研究共纳入153例患者。147例患者有CT小肠造影检查结果，诊断阳性率为96%。其中，58.16%（89/153）为CD，26.14%（40/153）为ITB，6.5%（10/153）为感染性回肠炎，9.15%（14/153）经组织病理学检查结果不明确。CT小肠造影正确识别出78.65%（70/89）的CD和75%（30/40）的ITB。CT小肠造影诊断CD的敏感性为78.65%，特异性为67.19%，阳性预测值为76.92%，诊断准确性为73.86%；诊断ITB的敏感性为75%，特异性为87.61%，阳性预测值为68.18%，诊断准确性为84.31%。
CT小肠造影对内镜检查意义不明确的回盲部黏膜病变具有较高的诊断阳性率。CD和ITB是这些患者中检测到的主要疾病。CT小肠造影在检测这两种疾病方面具有良好的诊断性能。
