本文選題：腸疾病 + 克羅恩病��； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：本課題分為兩部分，第一部分：以臨床懷疑小腸克羅恩病患者為研究對(duì)象，并以腸鏡、手術(shù)和病理證實(shí)為最終診斷結(jié)果，通過(guò)分析患者M(jìn)RI、CT圖像，總結(jié)Crohn患者的影像學(xué)特征，為臨床診斷小腸Crohn病提高更好的依據(jù)。第二部分，以臨床確診Crohn患者為研究對(duì)象，以臨床評(píng)價(jià)Crohn活動(dòng)性為標(biāo)準(zhǔn)，通過(guò)患者M(jìn)RI表現(xiàn)，評(píng)估其活動(dòng)性，，為臨床評(píng)估Crohn病的活動(dòng)性提供影像依據(jù)。 第一部分：腸管Crohn病MRI、CT影像特征及兩者比較分析 目的：以臨床懷疑小腸CD患者為研究對(duì)象，并以腸鏡、手術(shù)和病理證實(shí)為最終診斷結(jié)果，分析小腸克羅恩病的MRI、CT影像特征，并對(duì)二者進(jìn)行分析比較，總結(jié)CD患者的影像學(xué)特征，為臨床診斷小腸Crohn病提高更好的依據(jù)。 材料與方法：選取臨床懷疑為CD患者共43人，所有患者均接受了小腸MRI檢查、腹盆腔CT平掃及增強(qiáng)檢查、腸鏡檢查。兩名高年資MRI科醫(yī)生和兩名高年資CT醫(yī)生分別對(duì)43例小腸MRI和CT影像圖像從病變部位、累及范圍、腸壁形態(tài)及粘膜改變、腸腔外病變的顯示情況等多方面予以判斷。對(duì)結(jié)果予以匯總、記錄，并與手術(shù)病理結(jié)果、內(nèi)鏡結(jié)果進(jìn)行對(duì)比。 結(jié)果：43例患者經(jīng)腸鏡、病理及手術(shù)證實(shí)的克羅恩病31例，潰瘍性結(jié)腸炎4例、胃腸間質(zhì)瘤2例、腸結(jié)核1例、淋巴瘤1例、腹型紫癜1例，正常3例。MRI對(duì)CD的檢出率為93.5%（29/31），CT對(duì)CD的檢出率為90.3%（28/31），MRI結(jié)合腸鏡對(duì)CD的檢出率為96%，且MRI對(duì)小腸疾病的檢測(cè)效果同CT小腸檢查一致性好（Kappa值=0.788,P 0.01）。病變多累及多節(jié)段腸管，MRI及CT平均每例2.8/3段，累及回盲部者27/25例（93%/89%）。MRI平掃即可顯示腸壁增厚程度及“梳齒征”。克羅恩病患者腸壁輕中度增厚時(shí)以偏心性增厚為主（42/51、45/53），在重度增厚的腸壁中以環(huán)形增厚為主（24/31、25/32），在MRI與CT檢查中兩者均有統(tǒng)計(jì)學(xué)意義（P 0.001）。但MRI與CT在腸壁環(huán)形增厚與偏心性增厚中均無(wú)統(tǒng)計(jì)學(xué)意義（兩者P0.05）。12例CD患者 并發(fā)肛瘺或肛周膿腫，CT未能檢出。 結(jié)論：CT和MRI腸管掃描結(jié)果相仿，可成為小腸疾病的影像學(xué)檢查方式；兩者均可以清楚顯示腸壁增厚程度及腸外病變，而MRI更適合于檢測(cè)瘺管和膿腫，且MRI 更適用于病人長(zhǎng)期隨訪應(yīng)用。 第二部分：MRI在評(píng)估Crohn病活動(dòng)性中的應(yīng)用及其臨床對(duì)比研究 目的：以臨床確診CD患者為研究對(duì)象，以臨床評(píng)價(jià)CD活動(dòng)性為標(biāo)準(zhǔn)，通過(guò)患者M(jìn)RI圖像表現(xiàn)，評(píng)估其活動(dòng)性，為臨床評(píng)估CD活動(dòng)性提供影像依據(jù)。 材料與方法：44例臨床確診為CD患者（其中男32例，女性12例），并搜集44例患者臨床資料，所有患者均接受了腸管MRI檢查。將患者根據(jù)資料及MRI圖像分為活動(dòng)期與慢性期。分析患者M(jìn)R圖像特征，包括病變腸管腸壁增厚及腸腔狹窄程度、有無(wú)“梳齒征”、腸系膜淋巴結(jié)增大、有無(wú)并發(fā)癥（包括瘺管及竇道形成）等，由此分析患者活動(dòng)性，并與臨床對(duì)比。 結(jié)果：44例臨床確診的CD患者中，臨床評(píng)價(jià)為活動(dòng)期者28例（輕中度活動(dòng)期22例，重度活動(dòng)期6例），慢性期16例。MRI圖像評(píng)估為活動(dòng)期27例，慢性期17例。以臨床評(píng)估作為判斷克羅恩病活動(dòng)性的金標(biāo)準(zhǔn)，MRI評(píng)估活動(dòng)性克羅恩病的敏感度為89.3%，特異度為87.5%，陽(yáng)性預(yù)測(cè)值為92.6%，陰性預(yù)測(cè)值為82.4，且臨床評(píng)價(jià)CD活動(dòng)期及慢性期與MR評(píng)價(jià)效果一致性好（Kappa值=0.758）�？肆_恩病腸管MRI表現(xiàn)為多節(jié)段腸壁增厚者37例，回腸末端（回盲部）受累者40例，淋巴結(jié)增大者18例，19例發(fā)現(xiàn)“梳齒征”，22例形成瘺（包括3例腸瘺及19例肛瘺）。活動(dòng)期患者腸壁重度增厚、腸腔狹窄、腸外并發(fā)癥中肛瘺、淋巴結(jié)腫大、梳齒征的發(fā)生率高于慢性期，兩組間比較，差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。 結(jié)論：MR在診斷克羅恩病及評(píng)價(jià)克羅恩病活動(dòng)性方面與臨床評(píng)估一致性良好，而且通過(guò)對(duì)腸壁增厚、黏膜異常強(qiáng)化、病變部位、腸管外炎性反應(yīng)等這些征象，做出了正確診斷。此外，MRI可作為克羅恩病腸外并發(fā)癥檢查的首選影像學(xué)方法。
[Abstract]:This subject is divided into two parts , the first part : the clinical suspicion of Crohn ' s disease as the research object , and the clinical diagnosis of Crohn ' s disease by analyzing the MRI and CT images of the patients . The second part , based on the clinical diagnosis of Crohn ' s disease , assesses the activity of Crohn ' s disease by MRI , and provides the basis for clinical assessment of the activity of Crohn ' s disease .

Part I : MRI , CT imaging features and comparative analysis of Crohn ' s disease

Objective : To investigate the MRI and CT imaging features of small intestinal Crohn ' s disease ( CD ) by clinical suspicion of small intestinal CD patients and to analyze the MRI and CT image features of Crohn ' s disease .

Materials and Methods : 43 patients with CD were suspected to be clinically suspected . All patients received small intestine MRI examination , abdominal pelvic CT plain scan and enhanced examination and enteroscopy . Two high - aged MRI doctors and two high - aged CT doctors respectively judged 43 cases of small intestine MRI and CT images from the lesion site , the accumulation range , the intestinal wall morphology and the mucosal changes , the display of the external lesions of the intestinal cavity , etc . The results were summarized and recorded , and compared with the pathological results and endoscopic results .

Results : There were 31 cases of Crohn ' s disease confirmed by enteroscopy , pathology and operation , 4 cases of ulcerative colitis , 2 cases of gastrointestinal stromal tumor , 1 case of intestinal tuberculosis , 1 case of lymphoma , 1 case of abdominal type purpura and 3 normal cases . The detection rate of CD was 90.3 % ( 28 / 31 ) . MRI and CT averaged 2.8 / 3 and 27 / 25 cases ( 93 % / 89 % ) . The thickening degree of intestinal wall and the " comb sign " were observed in patients with Crohn ' s disease ( 42 / 51 , 45 / 53 ) . In severe thickened intestinal wall , the thickening was mainly ( 24 / 31 , 25 / 32 ) . Both MRI and CT were statistically significant ( P 0.001 ) . But there was no statistical difference between MRI and CT ( P0.05 ) .

CT could not be detected by anal fistula or perianal abscess .

Conclusion : The results of CT and MRI were similar to those of MRI .
Both can clearly show intestinal wall thickening and extraintestinal lesions , while MRI is more suitable for detection of fistula and abscess , and MRI

and is more suitable for long - term follow - up application of patients .

Part Two : Application of MRI in Evaluation of Crohn ' s Disease Activity and Its Clinical Comparative Study

Objective : To evaluate the activity of CD patients with CD activity and to provide evidence for clinical evaluation of CD activity .

Materials and Methods : 44 cases were diagnosed as CD patients ( 32 males and 12 females ) , and 44 patients received clinical data . All patients were divided into active phase and chronic phase according to the data and MRI images . The patient ' s MR image features were analyzed , including the thickening of intestinal wall and the degree of intestinal stenosis , the presence or absence of " comb sign " , the enlargement of mesenteric lymph nodes , the presence or absence of complications ( including fistula and sinus formation ) , etc . The patient activity was analyzed and compared with clinical .

Results : Among 44 cases of CD patients diagnosed clinically , 28 cases ( 22 cases of mild to moderate activity , 6 cases with severe active period ) and 16 cases of chronic phase were evaluated clinically . The sensitivity of MRI was 89.3 % , specificity was 87.5 % , positive predictive value was 92.6 % , negative predictive value was 82.4 .

Conclusion : MR is good in diagnosis of Crohn ' s disease and evaluation of Crohn ' s disease activity , and is correctly diagnosed by these signs , such as thickening of intestinal wall , abnormal enhancement of mucous membrane , site of lesion , inflammatory response of intestinal canal , etc . Furthermore , MRI can be used as the preferred imaging method for Crohn ' s disease ' s disease .

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R574

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周強(qiáng);張言斌;湯春梅;肖海浩;;克羅恩病與腸結(jié)核鑒別診斷對(duì)比分析[J];當(dāng)代醫(yī)學(xué);2009年06期

2 任小軍;章士正;;MR注氣小腸灌腸及水成像對(duì)小腸疾病診斷價(jià)值的比較[J];放射學(xué)實(shí)踐;2006年03期

3 張冬艷;薛雁山;;肝纖維化與磁共振擴(kuò)散成像ADC值的相關(guān)性研究現(xiàn)狀[J];國(guó)際醫(yī)學(xué)放射學(xué)雜志;2011年04期

4 劉丹;呂發(fā)金;張翱;楊全;向波;;多層螺旋CT對(duì)潰瘍性結(jié)腸炎的診斷價(jià)值[J];重慶醫(yī)學(xué);2012年21期

5 朱震亞;朱炯;李磊;龔紅霞;許建榮;;3.0T和1.0TMRI評(píng)估克羅恩病活動(dòng)性的研究[J];磁共振成像;2012年06期

6 孫應(yīng)實(shí),張曉鵬,邵尉,徐剛,徐克;潰瘍性結(jié)腸炎的CT表現(xiàn)附10例報(bào)道[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2001年04期

7 沈蓓蕾;朱時(shí)鏘;蔣家康;;胃腸道間質(zhì)瘤的CT診斷價(jià)值[J];實(shí)用放射學(xué)雜志;2006年03期

8 張繼斌;范覺昕;許建銘;李偉;秦明明;劉仁堅(jiān);;腸道磁共振水成像檢查技術(shù)探討[J];實(shí)用放射學(xué)雜志;2008年08期

9 袁媛;范一宏;高旭寧;呂賓;;3.0T MRI在克羅恩病中的臨床應(yīng)用和價(jià)值[J];胃腸病學(xué);2011年11期

10 王健;賈紅;;膠囊內(nèi)鏡在小腸Crohn病的應(yīng)用[J];世界華人消化雜志;2007年16期

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