Dane Bari, Dillman Jonathan R, Fidler Jeff, Anupindi Sudha A, Fulmer Clifton G, Gordon Ilyssa O, Bruining David H, Deepak Parakkal, Abualruz Abdul-Rahman, Al-Hawary Mahmoud, Altinmakas Emre, Guglielmo Flavius F, Jaffe Tracy, Rimola Jordi, Bettenworth Dominik, Rieder Florian, Fletcher Joel G, Baker Mark E
Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016.
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Radiology. 2025 Jul;316(1):e243123. doi: 10.1148/radiol.243123.
More than half of patients with Crohn disease will develop strictures. Strictures are areas of bowel luminal narrowing composed of a combination of inflammatory cells, muscular hypertrophy, and fibrosis. Most patients with strictures eventually require endoscopic or surgical intervention. This article reviews small bowel Crohn disease stricture histopathology, current imaging definitions and challenges, and stricture management. Current imaging-based stricture definitions use different criteria and do not recognize strictures without upstream dilation nor failed endoscopic passage. This consensus was endorsed by the Society of Abdominal Radiology and developed by the Society of Abdominal Radiology Inflammatory Bowel Disease Disease Focused Panel as well as gastroenterology and pathology experts in Crohn disease strictures. Updated imaging stricture definitions and recommendations are presented. Most importantly, the panel now defines a Crohn disease small bowel stricture using a threshold small bowel dilation of 2.5 cm (rather than 3.0 cm) and incorporates failed endoscopic passage, even when there is no associated bowel dilation at CT or MR enterography. With these updated imaging stricture definitions, it is hoped that patients with Crohn disease may benefit from more timely stricture identification and management.
超过半数的克罗恩病患者会出现狭窄。狭窄是肠腔变窄的区域，由炎症细胞、肌肉肥大和纤维化共同构成。大多数有狭窄的患者最终需要内镜或手术干预。本文综述了小肠克罗恩病狭窄的组织病理学、当前的影像学定义及挑战以及狭窄的处理。当前基于影像学的狭窄定义使用不同的标准，且未将无上游扩张或内镜通过失败的狭窄纳入其中。这一共识得到了腹部放射学会的认可，由腹部放射学会炎症性肠病专题小组以及克罗恩病狭窄方面的胃肠病学和病理学专家共同制定。文中给出了更新后的影像学狭窄定义及建议。最重要的是，该专题小组现在将小肠扩张阈值为2.5厘米（而非3.0厘米）且合并内镜通过失败（即使在CT或磁共振小肠造影时无相关肠扩张）定义为克罗恩病小肠狭窄。希望通过这些更新后的影像学狭窄定义，克罗恩病患者能从更及时的狭窄识别和处理中获益。
