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目的研究CT小肠造影对于小肠Crohn病的诊断价值及其限度。方法采用64层螺旋CT,对15例经肠镜、手术和病理诊断的小肠Crohn病患者口服等渗甘露醇后行腹盆CT扫描,包括平扫、动脉期和门脉期扫描,采用多平面重建(Multiplanar Reconstruction,MPR)技术,评价其CT异常征象。结果15例患者小肠充盈评分2.87±0.99(1～4分),CT小肠造影病变表现为肠壁增厚13例(87%),强化增加12例(80%)。发病部位仅累及末段回肠9例(60%),空回肠多个节段受累5例(33%),小肠和结肠同时受累1例。肠管周围蜂窝织炎6例(40%),脓肿和炎性肿块2例,瘘管形成1例。门脉期图像对诊断最有帮助。结论口服等渗甘露醇小肠充盈可满足诊断要求,CT小肠造影可显示Crohn病病变肠壁及其周围并发症,对于指导临床治疗以及评价临床疗效具有重要价值。
Objective To study the value and limitations of CT small bowel angiography in the diagnosis of Crohn’s disease of small intestine. Methods Sixty-four-slice spiral CT was performed on 15 patients with enteric Crohn’s disease who underwent colonoscopy, surgery and pathology. The patients underwent oral CT scan of abdominal cavity with isotonic mannitol, including plain scan, arterial and portal venous phase scanning, Reconstruction (Multiplanar Reconstruction, MPR) technology to assess the CT abnormal signs. Results Small intestinal filling score was 2.87 ± 0.99 (1 ~ 4) in 15 cases. Thirteen cases (87%) of intestinal wall thickening and 12 cases (80%) were reinforced by CT small bowel lesions. The incidence of site involved only the distal ileum in 9 cases (60%), ileum multiple segments involvement in 5 cases (33%), small intestine and colon at the same time involved in 1 case. 6 cases of cellulitis around the intestine (40%), 2 cases of abscess and inflammatory mass, and 1 case of fistula formation. Portal venous images are most helpful for diagnosis. Conclusion Oral osmotic mannitol intestinal filling can meet the diagnostic requirements, CT small bowel angiography can show Crohn disease lesions of the intestinal wall and its surrounding complications, for guiding the clinical treatment and evaluation of clinical efficacy of great value.