The Correlation analysis between MRI enterography and Crohn's disease activity index on Crohn's disease activity
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摘要:
目的探讨MRI小肠造影（MRE）对克罗恩病活动度分级的评估及其与临床克罗恩病活动指数（CDAI）的相关性。 方法对22例临床或病理确诊并经临床活动度分级的活动性克罗恩病患者行MRE检查。扫描后的图像由2名副主任及以上诊断医师对克罗恩病进行主观评分，并按其得分进行影像学活动度分级，比较评估结果与该患者临床分级结果相比较，观察其一致性。 结果22例活动性克罗恩病患者均完成MRE检查，其中轻度患者7例，得分6.5±1.7分，中位数6.0分；中度患者9例，得分11.9±1.6分，中位数12.0分；重度患者6例，得分24.0±5.4分，中位得分23.5分。Spearman相关分析显示，MRE克罗恩病轻度、中度、重度与临床CDAI相关系数分别为r=0.873、0.826、0.899（P < 0.05）。 结论MRE与临床CDAI具有相关性，可以对活动性克罗恩病的活动度分级进行准确评估，为临床治疗提供参考。 Abstract:ObjectiveTo explore the correlation between magnetic resonance imaging enterography (MRE)on the classification of Crohn's disease activity and clinical Crohn's disease activity index (CDAI). MethodsTwenty-two patients with active Crohn's disease diagnosed clinically or pathologically and graded by clinical activity were examined by MRE. The scanned images were scored subjectively by 2 deputy director or above diagnostic physicians, and the classification of image activity was conducted according to their scores. Then the Results were compared with the clinical classification Results of the patient, and the consistency was observed. ResultsAll 22 patients with active Crohn's disease completed MRE, of which 7 were mild patients with a score of 6.5±1.7 and a median of 6.0. Nine were moderate patients with a score of 11.9±1.6. The median was 12.0 points; 6 severe patients had a score of 24.0±5.4 points and the median was 23.5 points. Spearman correlation analysis was used to compare Crohn's disease activity grading criteria with clinical CDAI calculation methods. The correlations were r=0.873、0.826、0.899, respectively(P < 0.05). ConclusionMRE has a significant correlation with CDAI. It can assess the activity grade of active Crohn's disease accurately and provide reference for clinical treatment. -
Key words:
- MRI enterography /
- crohn's disease /
- activity grading /
- clinical activity index
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图 1 男，28岁，临床诊断为回肠末端克罗恩病，其影像学表现
A~B：增强扫描，病变区肠壁明显分层强化，呈“靶征”改变（箭）.
Figure 1. Male, 28 years old, the clinical diagnosis was Crohn's disease at the end of ileum, imaging features of MRI.
图 2 男，50岁，临床诊断为空肠末段、回肠起始段克罗恩病
A：T2WI，空肠末段、回肠起始段肠壁明显增厚，呈高信号（箭）；B~C：增强扫描，病变区明显不均匀强化（箭）；D：弥散加权成像（DWI B=800），病变区呈高信号，弥散受限（箭）.
Figure 2. Male, 50 years old, the clinical diagnosis was Crohn's disease at the end of jejunum and the beginning of ileum.
图 3 男，33岁，临床诊断为回肠末端克罗恩病
A~C：稳态进动快速成像（FIESTA），回肠远段呈克罗恩病改变，电影扫描动态观察，其动力较健康肠段动力减低（箭）.
Figure 3. Male, 33 years old, the clinical diagnosis was Crohn disease at the end of ileum.
图 4 克罗恩病患者MRE评分结果与临床CDAI值相关性分析散点图
Figure 4. The scatter plot of correlation between MRE score and clinical CDAI value in patients with Crohn's disease.
表 1 CDAI计算法
Table 1. CDAI calculation method
变量 权重 稀便次数（1周） 2 腹痛时间（1周总评，0=无；1=轻；2=中；3=重） 5 一般情况（1周总评，0~3分） 7 肠外表现与并发症（1项1分） 20 阿片类止泻药（0、1分） 30 腹部包块（可疑2分，肯定5分） 10 红细胞比容降低值（正常a：男0.47女0.42） 6 100×（1-体质量/标准体质量） 1 a中国人标准的血细胞比容正常值；取各项分值之和：缓解期CDAI < 150，活动期≥150分；轻度150~220分，中度221~450分，重度 > 450分. 
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表 2 MRE克罗恩病活动度评分标准
Table 2. MRE Crohn's disease activity score
项目 缓解期 活动期 0 1 2 3 T2WI信号强度 正常 3~5级 5~7级 7~15级 DWI受限程度 无 5~7级 7~10级 10~15级 增强方式 正常 均匀强化 黏膜强化 分层强化 肠壁厚度(mm) 0~3 3~5 5~9 ≥10 病变累及范围(mm) 0 0~50 50~150 ≥151 病变区肠道动力变化 正常（无动力） 动力降低 动力正常 动力增加 肠系膜区淋巴结(个) 0 0~3 3~7 > 7 梳齿征 无 有 表中范围不包含“~”前的数值且包含“~”后的数值.
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表 3 MRE克罗恩病活动度分级标准
Table 3. MRE Crohn's disease activity classification criteria
无 没有疾病活动迹象 轻度 ①活动迹象，但无并发症；②没有评分为3分的活动迹象；③总得分≤10分 中度 ①活动迹象，但无并发症；②得分11~15分或包含1项评分为3分的活动迹象 重度 ①活动迹象；②总得分≥16分或至少存在1个并发症 克罗恩病并发症：肠管周围蜂窝织炎、肠腔狭窄、瘘管及脓肿.
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表 4 克罗恩病MRE活动度与临床CDAI的相关性
Table 4. Correlation between MRE activity classification standard and clinical CDAI calculation method in Crohn's disease
克罗恩病活动度 r P 轻度 0.873 0.01 中度 0.826 0.006 重度 0.899 0.015 经MRE检查克罗恩病活动性分级后，轻度及重度患者与CDAI具有相关性，中度患者与CDAI显著相关.
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