Boland G W, Lee M J, Cats A M, Ferraro M J, Matthia A R, Mueller P R
Department of Radiology, Massachusetts General Hospital, Boston.
Clin Radiol. 1995 Mar;50(3):153-6. doi: 10.1016/s0009-9260(05)83045-4.
Clinical records and abdominal CT scans from 64 patients with documented Clostridium difficile disease were reviewed to determine if any correlation existed between CT findings of colitis and severity of clinical disease. Clostridium difficile disease was documented with stool toxin titre levels and CT scans were performed within 3 days of stool sample. Clinical disease severity was estimated by tabulating the degree of fever, WBC count, frequency and duration of diarrhoea. Thirty-nine of 64 patients showed CT evidence of colitis of which 28/39 showed evidence of focal colitis and 11/39 had pancolitis. CT findings suggesting colitis included colonic wall thickening (39 patients), nodular mucosal thickening (11 patients), the 'accordion pattern' (3 patients), pericolonic oedema (27 patients) and ascites (10 patients). Twenty-five of 64 patients showed no CT evidence of colitis. The clinical severity of disease did not statistically differ (P < 0.05) between patients with CT evidence of colitis and those without colitis. The only CT finding that correlated with clinical severity of disease was nodular mucosal thickening which was found with significantly (P < 0.05) more frequency in patients with a WBC count > 11,000 mm3. CT changes with Cl. difficile disease correlate poorly with the clinical severity. This and negative findings do not exclude the disease.
回顾了64例有艰难梭菌病记录患者的临床记录和腹部CT扫描结果，以确定结肠炎的CT表现与临床疾病严重程度之间是否存在任何相关性。通过粪便毒素滴度水平记录艰难梭菌病，并在采集粪便样本后3天内进行CT扫描。通过将发热程度、白细胞计数、腹泻频率和持续时间制成表格来评估临床疾病严重程度。64例患者中有39例显示结肠炎的CT证据，其中28/39显示局灶性结肠炎证据，11/39有全结肠炎。提示结肠炎的CT表现包括结肠壁增厚（39例患者）、结节状黏膜增厚（11例患者）、“手风琴样”表现（3例患者）、结肠周围水肿（27例患者）和腹水（10例患者）。64例患者中有25例未显示结肠炎的CT证据。有结肠炎CT证据的患者与无结肠炎患者之间的疾病临床严重程度在统计学上无差异（P<0.05）。唯一与疾病临床严重程度相关的CT表现是结节状黏膜增厚，在白细胞计数>11,000/mm³的患者中出现频率显著更高（P<0.05）。艰难梭菌病的CT改变与临床严重程度相关性较差。这一情况及阴性结果并不排除该疾病。
