弥散加权成像在活动期溃疡性结肠炎定量评估中的应用

黄捷欣; 胡炜; 刘卉; 王忠

doi:10.12122/j.issn.1674-4500.2023.02.21

弥散加权成像在活动期溃疡性结肠炎定量评估中的应用

doi: 10.12122/j.issn.1674-4500.2023.02.21

黄捷欣^1,,
胡炜^2, ,,
刘卉³,
王忠⁴

1.
重庆市红十字会医院(江北区人民医院)放射科，重庆 400000
2.
重庆市九龙坡区人民医院消化内科，重庆 400000
3.
陆军特色医学中心消化内科，重庆 400042
4.
重庆市巴南区第二人民医院放射科，重庆 400054

基金项目:

重庆市卫生计生委2016年医学科研计划项目 2016ZDXM040

详细信息

作者简介:
黄捷欣，主治医师，E-mail: jessie_596@163.com

通讯作者:
胡炜，主治医师，E-mail: shirleyhv23@126.com

计量
- 文章访问数: 210
- HTML全文浏览量: 159
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-21
- 网络出版日期: 2023-04-28
- 刊出日期: 2023-03-20

Application of diffusion weighted imaging in quantitative evaluation of active ulcerative colitis

HUANG Jiexin^1
,,
HU Wei^{2
, ,},
LIU Hui³,
WANG Zhong⁴

1.
Department of Radiology, Chongqing Red Cross Hospital (Jiangbei District People's Hospital), Chongqing 400000, China
2.
Department of Gastroenterology, Chongqing Jiulongpo District People's Hospital, Chongqing 400000, China
3.
Department of Gastroenterology, Army Characteristic Medical Center, Chongqing 400042, China
4.
Department of Radiology, the Second People's Hospital of Banan District, Chongqing, Chongqing 400054, China

摘要

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。
- 溃疡性结肠炎 /
- CT /
- MRI /
- 弥散加权成像 /
- 诊断价值
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.
- ulcerative colitis /
- CT /
- MRI /
- diffusion weighted imaging /
- diagnostic value

HTML全文

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.

下载: 全尺寸图片幻灯片

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.

下载: 全尺寸图片幻灯片

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.

下载: 全尺寸图片幻灯片

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.

下载: 导出CSV

参考文献(25)

[1]	Lee SH, Walshe M, Oh EH, et al. Early changes in serum albumin predict clinical and endoscopic outcomes in patients with ulcerative colitis starting anti-TNF treatment[J]. Inflamm Bowel Dis, 2021, 27(9): 1452-61. doi: 10.1093/ibd/izaa309
[2]	万健, 张玉洁, 王敏, 等. 溃疡性结肠炎相关异型增生和溃疡性结肠炎相关性结直肠癌56例的临床特征[J]. 中华消化杂志, 2021, 41(10): 660-4. doi: 10.3760/cma.j.cn311367-20210518-00285
[3]	赵慧, 黄丽萍. 超声在炎症性肠病中的应用进展[J]. 中国医学影像学杂志, 2020, 28(9): 717-20. doi: 10.3969/j.issn.1005-5185.2020.09.020
[4]	李琛妮, 蓝华, 施佳伶, 等. 中性粒细胞/淋巴细胞比值等4项指标对溃疡性结肠炎内镜活动度的判断价值[J]. 中国实用内科杂志, 2021, 41(1): 55-9. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202101017.htm
[5]	庄晓曌, 李建军, 符莉莉, 等. 3.0 T多模态肠道MRI在溃疡性结肠炎定量评估中的应用[J]. 中山大学学报: 医学版, 2019, 40(2): 277-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYK201902016.htm
[6]	李璐, 梁宗辉. 炎症性肠病的MRI进展[J]. 国际医学放射学杂志, 2019, 42(4): 454-7. doi: 10.19300/j.2019.Z6791
[7]	吴开春, 梁洁, 冉志华, 等. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中国实用内科杂志, 2018, 38(9): 796-813. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201809007.htm
[8]	罗婷婷, 田秀峰, 樊志媛. 一对一护理模式在溃疡性结肠炎患者中的应用[J]. 罕少疾病杂志, 2020, 27(6): 70-1. doi: 10.3969/j.issn.1009-3257.2020.06.028
[9]	Sandborn WJ, Ghosh S, Panes J, et al. Efficacy of upadacitinib in a randomized trial of patients with active ulcerative colitis[J]. Gastroenterology, 2020, 158(8): 2139-49. e14. doi: 10.1053/j.gastro.2020.02.030
[10]	胡起立, 宋黎涛, 黄松. 3.0T动态增强MRI联合fPSA/tPSA检测对前列腺癌的诊断效能[J]. 影像科学与光化学, 2020, 38(5): 871-5. https://www.cnki.com.cn/Article/CJFDTOTAL-GKGH202005020.htm
[11]	Li Y, Schaarschmidt B, Umutlu L, et al. ¹⁸F‑FDG PET‑MR enterography in predicting histological active disease using the Nancy index in ulcerative colitis: a randomized controlled trial[J]. Eur J Nucl Med Mol Imaging, 2020, 47(4): 768-77. doi: 10.1007/s00259-019-04535-w
[12]	沈丹平. 多层螺旋CT肠道造影在评估溃疡性结肠炎病情程度中的应用价值探讨[J]. 中国CT和MRI杂志, 2021, 19(9): 128-30. doi: 10.3969/j.issn.1672-5131.2021.09.041
[13]	姬丽娟, 万书友, 李琮, 等. 特发性肠系膜静脉硬化性结肠炎多层螺旋CT表现[J]. 中国医学影像技术, 2021, 37(5): 795-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202105048.htm
[14]	张咏雪, 单华, 周金彬. 多层螺旋CT小肠造影对炎症性肠病的诊断价值[J]. 影像科学与光化学, 2021, 39(2): 315-9. https://www.cnki.com.cn/Article/CJFDTOTAL-GKGH202102027.htm
[15]	Alshammari MT, Stevenson R, Abdul‑Aema B, et al. Diagnostic accuracy of non-invasive imaging for detection of colonic inflammation in patients with inflammatory bowel disease: a systematic review and meta-analysis[J]. Diagnostics (Basel), 2021, 11(10): 1926.
[16]	王静, 刘刚. 多层螺旋CT小肠造影和消化内镜对炎性肠病的诊断价值[J]. 山西医药杂志, 2019, 48(18): 2227-8. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY201918008.htm
[17]	周志厚, 王孟丽, 胡伟, 等. MRI与内镜在溃疡性结肠炎评估中的对比研究[J]. 中华生物医学工程杂志, 2016, 22(2): 124-6.
[18]	Pabla BS, Schwartz DA. Assessing severity of disease in patients with ulcerative colitis[J]. Gastroenterol Clin North Am, 2020, 49(4): 671-88.
[19]	Podgórska J, Pasicz K, Zagórowicz E, et al. Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study[J]. Acta Radiol, 2021, 62(4): 439-46.
[20]	彭颖, 徐丽红. 溃疡性结肠炎疾病活动病理组织学评价指标的应用现状[J]. 中国全科医学, 2021, 24(21): 2634-9. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202121002.htm
[21]	Nakase H, Sato N, Mizuno N, et al. The influence of cytokines on the complex pathology of ulcerative colitis[J]. Autoimmun Rev, 2022, 21(3): 103017.
[22]	杨东, 王培军, 宋彬, 等. 磁共振结肠成像结合DWI在活动期溃疡性结肠炎的应用[J]. 放射学实践, 2016, 31(3): 252-7. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS201603022.htm
[23]	Djelouah M, Marical V, Kanagaratnam L, et al. Diagnosis of postoperative recurrence of Crohn disease with MR-enterography: value of diffusion-weighted imaging[J]. Diagn Interv Imaging, 2021, 102(12): 743-51.
[24]	朱孟娟, 何竹, 蔡德春. 多层螺旋CT小肠增强造影与结肠镜检查炎症性肠病对比分析[J]. 现代消化及介入诊疗, 2019, 24(12): 1485-8. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXH201912034.htm
[25]	陈晨. 多层螺旋CT检查在诊断溃疡性结肠炎中的应用价值探讨[J]. 中国CT和MRI杂志, 2019, 17(11): 117-9. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR201911037.htm