偽膜性結(jié)腸炎MSCT表現(xiàn)并與結(jié)腸炎癥性腸病的對照研究
發(fā)布時間：2019-06-12 13:36
【摘要】：目的：總結(jié)偽膜性結(jié)腸炎（Pseudomembranous Colitis，PMC）的多層螺旋CT（Multi-slice spiral CT，MSCT）表現(xiàn)，并與結(jié)腸炎癥性腸病（Inflammatory BowelDisease，IBD）對照研究，旨在提高偽膜性結(jié)腸炎的CT診斷與鑒別診斷水平。 材料和方法：收集并分析經(jīng)臨床、病理證實的偽膜性結(jié)腸炎及結(jié)腸炎癥性腸病的影像資料。偽膜性結(jié)腸炎13例，其中男6例，女7例，年齡49-88歲，平均(68.62±11.90)歲。全部病例均有抗生素治療史，均有腹瀉癥狀，其中每日腹瀉5-10次8例，10次5例。結(jié)腸炎癥性腸病35例，包括克羅恩病(Crohn’s disease，CD)14例，潰瘍性結(jié)腸炎(Ulcerative Colitis，UC）21例。14例結(jié)腸克羅恩病中，男8例，女6例，年齡16-80歲，平均(37.1±19.54)歲。21例潰瘍性結(jié)腸炎中，男6例，女15例，年齡24-87歲，，平均(66.9±13.91)歲。結(jié)腸炎性腸病的臨床癥狀包括腹痛、腹瀉、粘液膿血便等。全部病例均行MSCT檢查。檢查前禁食8h以上，檢查前1小時口服2.5%等滲甘露醇溶液或1.5%泛影葡胺1000-1500ml，病情危重或急腹癥患者不口服對比劑直接掃描。CT掃描范圍從膈頂至恥骨聯(lián)合下緣，增強掃描分動脈期（延遲28-35s）、靜脈期（延遲70-75s），對比劑為非離子型碘對比劑80-100ml，注射流率2.5-3.0ml/s。掃描圖像經(jīng)工作站后處理。以增強后腸壁強化程度大于鄰近腸壁強化程度為強化增加的判斷依據(jù)。以腸壁厚度≥4mm作為腸壁增厚的判斷標準，腸壁增厚程度可分為輕度（4-10mm）、中度（11-15mm）、重度（15mm）。分析每一個病例的MSCT表現(xiàn)，包括病變部位，病變范圍，腸壁增厚，強化增加，腸壁分層，腸系膜血管增多等。分別由兩名具有胃腸道影像診斷經(jīng)驗，不知曉臨床、病理和其他影像資料的高年資放射科醫(yī)師對圖像進行隨機、獨立閱片，描述病變征象，并做出診斷。所有數(shù)據(jù)均應(yīng)用SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析。α=0.05，P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果：⑴偽膜性結(jié)腸炎13例共67個結(jié)腸段受累，其中9例累及全結(jié)腸。13例均出現(xiàn)腸壁增厚，厚度范圍10-28mm，平均(20±4.49)mm，其中重度增厚11例（84.62%），腸壁不規(guī)則、結(jié)節(jié)狀增厚8例，強化增加7例，腸壁分層（“靶征”）7例，結(jié)腸皺襞異常增厚、內(nèi)突（“指紋征”）3例，造影劑聚積于增厚的橫行皺襞間（“手風(fēng)琴征”）2例，腸系膜血管增多（“梳征”）6例，腸管周圍索條狀滲出12例，腹水9例，胸水7例，皮下水腫6例，系膜淋巴結(jié)短徑平均（1.92±2.47）mm；⑵結(jié)腸克羅恩病14例，均為多節(jié)段病變，腸壁增厚14例，“靶征”11例，“梳征”14例，纖維脂肪增生14例，腸周蜂窩織炎7例，腹腔膿腫1例，肛周病變3例，淋巴結(jié)短軸平均（7.29±4.97)mm。潰瘍性結(jié)腸炎21例，腸壁增厚19例，“靶征”12例，腸管形態(tài)改變12例，黏膜面鋸齒狀改變13例，黏膜下氣泡13例，“梳征”11例，腹水4例。淋巴結(jié)短軸平均（3.52±2.6)mm；⑶與結(jié)腸炎癥性腸病相比，偽膜性結(jié)腸炎病變范圍廣，腸壁重度并呈不規(guī)則、結(jié)節(jié)狀增厚，易出現(xiàn)“指紋征”或“手風(fēng)琴征”、腸周索條狀滲出、腹水、胸水、皮下水腫（P0.05）。結(jié)腸克羅恩病易累及小腸，易出現(xiàn)“梳征”、腸周纖維脂肪增生及蜂窩織炎（P0.05）。潰瘍性結(jié)腸炎易出現(xiàn)粘膜鋸齒狀改變、黏膜下氣體和腸管形態(tài)改變（P0.05）；⑷13例偽膜性結(jié)腸炎患者均行纖維結(jié)腸鏡檢查，其中12例因腸腔狹窄結(jié)腸鏡不能通過，狹窄段以上結(jié)腸未能完成檢查。腸鏡檢查共發(fā)現(xiàn)病變結(jié)腸29段，少于MSCT的67個結(jié)腸段。MSCT評價病變結(jié)腸范圍較纖維結(jié)腸鏡有顯著優(yōu)勢（P0.05）。 結(jié)論：⑴偽膜性結(jié)腸炎的MSCT表現(xiàn)具有一定特征性，與結(jié)腸克羅恩病及潰瘍性結(jié)腸炎有區(qū)別；⑵掌握偽膜性結(jié)腸炎和結(jié)腸炎癥性腸病的MSCT特點并結(jié)合病史，有助于提高兩者鑒別診斷水平；⑶MSCT在評價病變范圍方面優(yōu)于纖維結(jié)腸鏡。
[Abstract]:Objective: To study the multi-slice spiral CT (MSCT) expression of pseudomembranous colitis (PMC) and to compare with the control of the inflammatory bowel disease (IBD) in the colon. The purpose of this study is to improve the CT diagnosis and differential diagnosis of pseudomembranous colitis. Materials and Methods: Collection and analysis of clinical, pathologically proven pseudomembranous colitis and imaging of the colon inflammatory bowel disease Materials:13 cases of pseudomembranous colitis,6 of which were male,7 female,49 to 88 years old, and average (68.62 to 11.90). The whole of the cases had a history of antibiotic treatment, with the symptoms of diarrhea, of which 5-10 times of daily diarrhea,8 cases,10 times A report of 35 cases of colonic inflammatory bowel disease, including 14 cases of Crohn's disease (CD),14 cases of ulcerative colitis (UC) and 21 cases of ulcerative colitis (UC). Example, age 24-87 years, average (66.9% 13.91) The clinical symptoms of colitis enteropathy include abdominal pain, diarrhea, and mucus pus and blood. et al. MSCT for all cases The test was carried out for more than 8 hours before the examination, 2.5% of the isotonic mannitol solution, or 1.5% of the diatrizoate,1000-1500ml, the condition of the disease or the acute abdomen were not directly scanned by the oral contrast agent in the patients with critical condition or acute abdomen before the examination. The scanning range of the CT is from the phrenic top to the pubic symphysis lower edge, the scanning sub-arterial phase (delayed 28-35 s), the venous phase (delay 70-75 s), the contrast agent is 80-100 ml of the non-ionic iodine contrast agent, and the injection flow rate is 2.5-3.0ml/ s. The scanned image is at the rear of the workstation The strengthening of the posterior wall of the intestinal wall is greater than that of the adjacent intestinal wall. The wall thickness of the intestinal wall can be divided into mild (4-10 mm), moderate (11-15 mm) and severe (15 mm) as a criterion for thickening of the intestinal wall with a thickness of 4 mm of the intestinal wall thickness. ). The MSCT manifestations of each case were analyzed, including the lesion site, the scope of the lesion, the thickening of the intestinal wall, the enhancement of the enhancement, the stratification of the intestinal wall, the increase of the mesenteric vessels, and the like. The images are randomly and independently read by two high-aged radiologists who have the experience of gastrointestinal image diagnosis, do not know the clinical, pathological and other image data, Break. All data are statistically separated using the SPSS17.0 statistical software The difference was significant between P = 0.05 and P 0.05. Results: There were 67 colon segments involved in 13 cases of pseudomembranous colitis, of which 9 cases were involved in the whole colon.13 of the 13 cases had the thickening of the intestinal wall, the thickness range of 10-28 mm, the average (20-4.49) mm, the severe thickening in 11 cases (84.62%), the irregular wall of the intestinal wall, the nodular thickening of 8 cases, and the enhancement of the increase. There were 7 cases,7 cases of intestinal wall delamination ("target sign"),7 cases of abnormal thickening of the colon,3 cases of internal process ("fingerprint sign"),2 cases of thickening,2 cases of internal process ("accordion sign"),6 cases of mesenteric vessel ("comb"),12 cases of strip exudation around the intestinal canal,9 cases of ascites, and chest. 7 cases of water,6 cases of subcutaneous edema, the average of the short diameter of the mesangial lymph nodes (1.92 and 2.47) mm,14 cases of Crohn's disease in the colon,14 cases of the intestinal wall thickening,11 cases of "target sign",14 cases of "comb",14 cases of fibrous fat hyperplasia,7 cases of periintestinal cellulitis, and the abscess of the abdominal cavity. 1 case of swelling,3 cases of perianal lesion and average of short axis of lymph node (7.29) 4.97 There were 21 cases of ulcerative colitis,19 cases of thickening of the intestinal wall,12 cases of "target sign",12 cases of the change of the intestinal canal,13 cases of the serrated change of the mucosal surface,13 cases of the submucosal bubbles,11 cases of "comb", and the abdomen. In 4 cases, the mean (3.52-2.6) mm of the short-axis of the lymph node, the range of the pseudomembranous colitis was wide, the intestinal wall was severe and irregular, the nodular thickening, the "fingerprint sign" or the "accordion sign" of the intestinal wall, the strip-like exudation of the intestine, the ascites, the pleural effusion and the subcutaneous edema (P0. 05). The colon Crohn's disease is easy to involve the small intestine, the appearance of the comb sign ", the periintestinal fiber fat hyperplasia and the cellulitis (P0. 05). The colon 29 of the lesion was found with an enteroscopy, which was less than 67 of the MSCT. Colonic segment. MSCT has a significant advantage over the fibrocolonoscope of the fibrocolonoscope (P0. Conclusion: The MSCT expression of pseudomembranous colitis is characteristic, and it is different from that of Crohn's disease and ulcerative colitis of the colon. The characteristics of the MSCT and the medical history of pseudomembranous colitis and inflammatory bowel disease of the colon can be grasped, and both of them can be improved. Do not diagnose the level; the MSCT is superior to the scope of the evaluation
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.5;R574.62
本文編號：2498066
[Abstract]:Objective: To study the multi-slice spiral CT (MSCT) expression of pseudomembranous colitis (PMC) and to compare with the control of the inflammatory bowel disease (IBD) in the colon. The purpose of this study is to improve the CT diagnosis and differential diagnosis of pseudomembranous colitis. Materials and Methods: Collection and analysis of clinical, pathologically proven pseudomembranous colitis and imaging of the colon inflammatory bowel disease Materials:13 cases of pseudomembranous colitis,6 of which were male,7 female,49 to 88 years old, and average (68.62 to 11.90). The whole of the cases had a history of antibiotic treatment, with the symptoms of diarrhea, of which 5-10 times of daily diarrhea,8 cases,10 times A report of 35 cases of colonic inflammatory bowel disease, including 14 cases of Crohn's disease (CD),14 cases of ulcerative colitis (UC) and 21 cases of ulcerative colitis (UC). Example, age 24-87 years, average (66.9% 13.91) The clinical symptoms of colitis enteropathy include abdominal pain, diarrhea, and mucus pus and blood. et al. MSCT for all cases The test was carried out for more than 8 hours before the examination, 2.5% of the isotonic mannitol solution, or 1.5% of the diatrizoate,1000-1500ml, the condition of the disease or the acute abdomen were not directly scanned by the oral contrast agent in the patients with critical condition or acute abdomen before the examination. The scanning range of the CT is from the phrenic top to the pubic symphysis lower edge, the scanning sub-arterial phase (delayed 28-35 s), the venous phase (delay 70-75 s), the contrast agent is 80-100 ml of the non-ionic iodine contrast agent, and the injection flow rate is 2.5-3.0ml/ s. The scanned image is at the rear of the workstation The strengthening of the posterior wall of the intestinal wall is greater than that of the adjacent intestinal wall. The wall thickness of the intestinal wall can be divided into mild (4-10 mm), moderate (11-15 mm) and severe (15 mm) as a criterion for thickening of the intestinal wall with a thickness of 4 mm of the intestinal wall thickness. ). The MSCT manifestations of each case were analyzed, including the lesion site, the scope of the lesion, the thickening of the intestinal wall, the enhancement of the enhancement, the stratification of the intestinal wall, the increase of the mesenteric vessels, and the like. The images are randomly and independently read by two high-aged radiologists who have the experience of gastrointestinal image diagnosis, do not know the clinical, pathological and other image data, Break. All data are statistically separated using the SPSS17.0 statistical software The difference was significant between P = 0.05 and P 0.05. Results: There were 67 colon segments involved in 13 cases of pseudomembranous colitis, of which 9 cases were involved in the whole colon.13 of the 13 cases had the thickening of the intestinal wall, the thickness range of 10-28 mm, the average (20-4.49) mm, the severe thickening in 11 cases (84.62%), the irregular wall of the intestinal wall, the nodular thickening of 8 cases, and the enhancement of the increase. There were 7 cases,7 cases of intestinal wall delamination ("target sign"),7 cases of abnormal thickening of the colon,3 cases of internal process ("fingerprint sign"),2 cases of thickening,2 cases of internal process ("accordion sign"),6 cases of mesenteric vessel ("comb"),12 cases of strip exudation around the intestinal canal,9 cases of ascites, and chest. 7 cases of water,6 cases of subcutaneous edema, the average of the short diameter of the mesangial lymph nodes (1.92 and 2.47) mm,14 cases of Crohn's disease in the colon,14 cases of the intestinal wall thickening,11 cases of "target sign",14 cases of "comb",14 cases of fibrous fat hyperplasia,7 cases of periintestinal cellulitis, and the abscess of the abdominal cavity. 1 case of swelling,3 cases of perianal lesion and average of short axis of lymph node (7.29) 4.97 There were 21 cases of ulcerative colitis,19 cases of thickening of the intestinal wall,12 cases of "target sign",12 cases of the change of the intestinal canal,13 cases of the serrated change of the mucosal surface,13 cases of the submucosal bubbles,11 cases of "comb", and the abdomen. In 4 cases, the mean (3.52-2.6) mm of the short-axis of the lymph node, the range of the pseudomembranous colitis was wide, the intestinal wall was severe and irregular, the nodular thickening, the "fingerprint sign" or the "accordion sign" of the intestinal wall, the strip-like exudation of the intestine, the ascites, the pleural effusion and the subcutaneous edema (P0. 05). The colon Crohn's disease is easy to involve the small intestine, the appearance of the comb sign ", the periintestinal fiber fat hyperplasia and the cellulitis (P0. 05). The colon 29 of the lesion was found with an enteroscopy, which was less than 67 of the MSCT. Colonic segment. MSCT has a significant advantage over the fibrocolonoscope of the fibrocolonoscope (P0. Conclusion: The MSCT expression of pseudomembranous colitis is characteristic, and it is different from that of Crohn's disease and ulcerative colitis of the colon. The characteristics of the MSCT and the medical history of pseudomembranous colitis and inflammatory bowel disease of the colon can be grasped, and both of them can be improved. Do not diagnose the level; the MSCT is superior to the scope of the evaluation
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.5;R574.62
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