Knollmann F D, Grünewald T, Adler A, Mäurer J, Hintze R E, Pohle H D, Felix R
Strahlenklinik und Poliklinik, Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität, Augustenburger Platz 1, D-13 353 Berlin, Germany.
Eur Radiol. 1997;7(9):1419-29. doi: 10.1007/s003300050310.
Intestinal symptoms affect most AIDS patients at some point in their disease. The purpose of this study was to evaluate the use of CT in this setting. A total of 339 abdominal CT exams were reviewed for signs of intestinal disease. Abdominal CT scans of 45 patients with intestinal symptoms were compared with colonoscopy and histologic data. The CT results were correlated with CD4( +) T-lymphocyte counts and patient survival. More than 14 % of all abdominal CT exams displayed signs of enteric disease. Of the 45 patients studied with both CT and colonoscopy, 35 (78 %) had signs of intestinal disease by CT. Of these 35 patients, colonoscopic signs of an intestinal lesion were found in 29 and histologic proof of disease was established in 30 cases. Colonoscopy and histology detected 8 lesions missed by CT. There were 14 cases of unspecific colitis, 15 cases of cytomegalovirus (CMV) colitis, and 4 cases of enteric tuberculosis as per biopsy. Five patients presented with Kaposi's sarcoma and 1 with a non-Hodgkin's lymphoma. Neither colonoscopic nor CT signs of intestinal disease did reliably distinguish between histologic subgroups. Specifically, CMV colitis could not be distinguished from unspecific colitis. CD4( +) T-lymphocyte counts for histologic subgroups were not significantly different, either. No colonoscopic or histologic feature predicted survival, whereas low CD4 counts and ascites on CT indicated a poor prognosis. Whereas CT detects signs of intestinal disease in most AIDS patients, these signs remain largely unspecific. Colonoscopy and biopsies provide no consistently valid standard with which to compare CT because of controversial sensitivity and specificity of these methods. The CT technique detects small bowel as well as extraintestinal disease. Therefore, CT is an important diagnostic modality in abdominal disease of immunocompromised patients.
肠道症状在大多数艾滋病患者病程的某个阶段都会出现。本研究的目的是评估CT在这种情况下的应用。我们回顾了339例腹部CT检查以寻找肠道疾病的迹象。将45例有肠道症状患者的腹部CT扫描结果与结肠镜检查及组织学数据进行比较。CT结果与CD4(+)T淋巴细胞计数及患者生存率相关。所有腹部CT检查中超过14%显示有肠道疾病迹象。在45例同时接受CT和结肠镜检查的患者中，35例（78%）CT显示有肠道疾病迹象。在这35例患者中，29例结肠镜检查发现有肠道病变迹象，30例有疾病的组织学证据。结肠镜检查和组织学检查发现了8处CT漏诊的病变。根据活检结果，有14例非特异性结肠炎、15例巨细胞病毒（CMV）结肠炎和4例肠结核。5例患者患有卡波西肉瘤，1例患有非霍奇金淋巴瘤。肠道疾病的结肠镜检查和CT征象均不能可靠地区分组织学亚组。具体而言，CMV结肠炎无法与非特异性结肠炎区分开来。组织学亚组的CD4(+)T淋巴细胞计数也无显著差异。没有结肠镜检查或组织学特征能预测生存率，而CT显示CD4计数低和有腹水提示预后不良。虽然CT能在大多数艾滋病患者中检测到肠道疾病迹象，但这些迹象在很大程度上仍不具特异性。由于结肠镜检查和活检方法的敏感性和特异性存在争议，因此它们无法提供与CT进行比较的始终有效的标准。CT技术能检测小肠及肠外疾病。因此，CT是免疫功能低下患者腹部疾病的重要诊断方法。
