Application of diffusion weighted imaging in quantitative evaluation of active ulcerative colitis
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摘要:
目的 探究弥散加权成像（DWI）对活动期溃疡性结肠炎（UC）的诊断价值。 方法 回顾性分析2018年至今于本院就诊治疗的80例UC患者的临床资料及影像学资料，以肠内镜诊断结果为“金标准”，将患者分为活动组（活动期UC，n=73）和非活动组（非活动期UC，n=7）。所有患者均接受CT、MRI检查，分析两组CT和MRI图像特征、表观弥散系数（ADC）值，采用ROC曲线评估ADC值对活动期UC的诊断价值。 结果 MRI检查显示，UC患者以结直肠粘膜及粘膜下层T1WI高信号或稍高信号、T2WI高信或等信号为主要MRI特征，所有病变肠段在DWI上信号不同程度增高。活动组ADC值小于非活动组（P < 0.05）；ROC曲线分析结果显示，ADC值诊断活动期UC的AUC值为0.795（95% CI：0.691~0.878，P < 0.05），具有较高的诊断效能。以肠内镜诊断结果为“金标准”，DWI诊断活动期UC的敏感度、准确率和阴性预测值均高于CT（P < 0.05）。 结论 UC的CT、MRI图像具有一定特征，DWI在活动期UC的鉴别诊断中具有良好的应用价值，可作为诊断UC病变时期的有效方法。 Abstract:Objective To investigate the diagnostic value of diffusion weighted imaging (DWI) in active ulcerative colitis (UC). Methods The clinical and imaging data of 80 patients with UC who were treated in the hospital from 2018 to the present were retrospectively analyzed. With the diagnostic results of intestinal endoscopy as the golden standard, the patients were divided into active group (UC in active phase, n=73) and inactive group (UC in inactive phase, n=7). All patients underwent CT and MRI examinations. The CT and MRI image features, apparent diffusion coefficient (ADC) values of the two groups were analyzed. ROC curve was used to evaluate the diagnostic value of ADC value in active UC. Results MRI findings mainly included colorectal mucosa and submucosa with high signal or slightly higher signal on T1WI, high signal or isointensity on T2WI. All diseased intestinal segments showed different degrees of increased signals on DWI. The ADC value of active group was significantly lower than that of inactive group (P < 0.05). The ROC curve analysis results showed that the AUC value of ADC value for diagnosing active UC was 0.795 (95% CI: 0.691-0.878, P < 0.05), indicating high diagnostic performance. With the diagnostic results of intestinal endoscopy as the golden standard, the sensitivity, accuracy and negative predictive value of DWI for diagnosing active UC were higher than those of CT (P < 0.05). Conclusion CT and MRI findings of UC are characteristic. DWI is helpful for differential diagnosis of active UC, and it can be used as an effective method for diagnosing the stage of UC. -
Key words:
- ulcerative colitis /
- CT /
- MRI /
- diffusion weighted imaging /
- diagnostic value
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图 1 患者女，52岁，反复腹痛2年余，左下腹为甚，轻中度隐痛，近1月加重，轻度腹泻，少粘液脓血便
CT平扫乙状结肠肠壁均匀增厚, 增强扫描肠壁分层强化, 静脉期可见周围系膜血管呈齿梳样改变.
Figure 1. A 52-year-old female patient with recurrent abdominal pain for more than 2 years, especially in the left lower abdomen, with mild to moderate dull pain which aggravated in the past month, mild diarrhea, and little mucopurulent bloody stool.
图 2 患者女，38岁，反复腹痛，腹泻3年
CT扫描平扫示直肠及乙状结肠肠壁均匀增厚，肠腔轻度狭窄, 乙状结肠局部肠壁内少许脂肪密度影沉积, 增强后动静脉期环形分层强化, 截面呈靶样.
Figure 2. A 38-year-old female patient with recurrent abdominal pain and diarrhea for 3 years.
图 3 ADC值诊断活动期UC的ROC曲线分析
Figure 3. ROC curve analysis of ADC value in the diagnosis of active UC.
表 1 CT、DWI检查对活动期UC的诊断价值比较
Table 1. Comparison of the diagnostic value of CT and DWI in active UC (%)
检查方法 敏感度 特异性 准确率 阳性预测值 阴性预测值 CT 89.04（65/73） 28.57（2/7） 83.75（67/80） 92.86（67/70） 20.00（2/10） DWI 98.63（72/73） 71.43（5/7） 96.25（77/80） 97.30（72/74） 83.33（5/6） χ2 - - 6.944 - - P 0.033 0.286 0.008 0.675 0.035 DWI: 弥散加权成像. 
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