磁共振弥散加权成像在评估Crohn’s肛瘘炎症活动度中的价值
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摘要
目的:探讨磁共振弥散加权成像(magnetic resonance dif fusion-weighted imaging,MR-DWI)在评估Crohn’s肛周瘘管炎症活动度中的价值。方法:回顾性分析55例经手术和/或肠镜证实的Crohn’s病伴发肛瘘患者的临床资料,所有患者在治疗前及治疗32周后分别行MRI检查。根据治疗结果将患者分为有效组(34例)和无效组(21例),分析两组患者治疗前后的MRI图像,测量表观弥散系数(apparent dif fusion coef f icient,ADC),采用配对t检验分析两组治疗前后ADC值的变化;同时以MRI评分作为参照,分析两组患者ADC值与MRI评分之间的相关性。结果:有效组治疗后ADC值高于治疗前(P<0.05),无效组治疗前后ADC值比较差异无明显统计学意义(P>0.05)。有效组治疗前后ADC值与MRI评分呈强负相关(r=–0.672, P<0.01),有效组+无效组治疗前后ADC值与MRI评分亦呈强负相关(r=–0.638,P<0.01)。结论:肛周瘘管ADC值变化与病灶炎症活动度相关,MR-DWI及ADC值测量可以较准确地判断Crohn’s肛瘘的炎症活动度。
Objective: To explore the value of magnetic resonance diffusion-weighted imaging(MR-DWI) for evaluating inflammatory activity of perianal Crohn's fistula.Methods: A total of 55 patients, who were diagnosed as perianal Crohn's fistula by surgery and/or endoscopy, were assessed retrospectively. All patients, underwent pelvic magnetic resonance imaging(MRI) before and 32 weeks aft er the treatment, were divided into 2 groups according to their response to treatment: an effective group(34 cases) and an ineffective group(21 cases). Th e MRI images of patients in the 2 groups were analyzed. Th e changes of apparent diffusion coefficient (ADC) values before and after treatment in the 2 groups were measured and compared by a paired t-test. An MRI-based score of perianal Crohn's disease severity was calculated as a reference standard, and the correlation between the ADC value and the MRI-based score was analyzed by using a Pearson correlation coefficient meth od.Results: In the effective group, the ADC values after therapy were significantly greater th an those before therapy(P<0.05), but in the ineffective group, there was no significant difference in the ADC value between after and before therapy(P>0.05). There was a strong negative correlation between the ADC values(after and before therapy) and the MRI-based scores in all the patients [in the effective group alone(r=–0.672, P<0.01) or in the effective group + the ineffective group(r=–0.638, P<0.01)].Conclusion: Changes in the ADC values of perianal fistula are related to the fistula activity. MRDWI and ADC value can accurately evaluate the inflammatory activity of perianal Crohn's fistula.
Objective: To explore the value of magnetic resonance diffusion-weighted imaging(MR-DWI) for evaluating inflammatory activity of perianal Crohn's fistula.Methods: A total of 55 patients, who were diagnosed as perianal Crohn's fistula by surgery and/or endoscopy, were assessed retrospectively. All patients, underwent pelvic magnetic resonance imaging(MRI) before and 32 weeks aft er the treatment, were divided into 2 groups according to their response to treatment: an effective group(34 cases) and an ineffective group(21 cases). Th e MRI images of patients in the 2 groups were analyzed. Th e changes of apparent diffusion coefficient (ADC) values before and after treatment in the 2 groups were measured and compared by a paired t-test. An MRI-based score of perianal Crohn's disease severity was calculated as a reference standard, and the correlation between the ADC value and the MRI-based score was analyzed by using a Pearson correlation coefficient meth od.Results: In the effective group, the ADC values after therapy were significantly greater th an those before therapy(P<0.05), but in the ineffective group, there was no significant difference in the ADC value between after and before therapy(P>0.05). There was a strong negative correlation between the ADC values(after and before therapy) and the MRI-based scores in all the patients [in the effective group alone(r=–0.672, P<0.01) or in the effective group + the ineffective group(r=–0.638, P<0.01)].Conclusion: Changes in the ADC values of perianal fistula are related to the fistula activity. MRDWI and ADC value can accurately evaluate the inflammatory activity of perianal Crohn's fistula.
引文
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[12]Yoshizakoa T,Wada A,Takahara T,et al.Diffusion-weighted MRI for evaluating perianal fistula activity:feasibility study[J].Eur J Radiol,2012,81(9):2049-2053.
[13]Horsth uis K,Lavini C,Bipat S,et al.Perianal Crohn’s disease:evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity[J].Radiology,2009,251(2):380-387.
[14]Karmiris K,Bielen D,Vanbeckevoort D,et al.Long-term monitoring of infliximab therapy for perianal fistulizing Crohn’s disease by using magnetic resonance imaging[J].Clin Gastroenterol Hepatol,2011,9(2):130-136.
[15]Tozer P,Ng SC,Siddiqui MR,et al.Long-term MRI-guided combined anti-TNF-alpha and th iopurine therapy for Crohn’s perianal fistulas[J].Inflamm Bowel Dis,2012,18(10):1825-1834.
[16]Krisztina BG,Willem B,Michael AK,et al.A global consensus on the classification,diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease[J].Gut,2014,63(9):1381-1392.
[17]Sahnan K,Pellino G,Adegbola SO,et al.Development of a model of th ree-dimensional imaging for the preoperative planning of Ta TME[J].Tech Coloproctol,2018,22(1):59-63.
[2]王瑞华,杨喆,叶兆祥.MRI在高位肛瘘瘘管定位及术后复发预测中的价值[J].天津医科大学学报,2017,23(1):35-37.WANG Ruihua,YANG Zhe,YE Zhaoxiang,et al.The value of MRIin the location of high perianal fistula and the prognosis of recurrence after surgery[J].Journal of Tianjin Medical University,2017,23(1):35-37.
[3]O’Malley RB,Al-Hawary MM,Kaza RK,et al.Rectal imaging:part 2,perianal fistula evaluation on pelvic MRI-What the radiologist needs to know[J].AJR,2012,199(1):W43-W53.
[4]Garg P,Singh P,Kaur,B.Magnetic resonance imaging(MRI):Operative findings correlation in 229 Fistula-in-Ano patients[J].World J Surg,2017,41(6):1618-1624.
[5]Van Assche G,Vanbeckevoort D,Bielen D,et al.Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease[J].Am J Gastroenterol,2003,98(2):332-339.
[6]Zou KH,Tuncali K,Silverman SG.Correlation and simple linear regression[J].Radiology,2003,227(3):617-622.
[7]Gecse K,Khanna R,Stoker J,et al.Fistulizing Crohn’s disease:Diagnosis and management[J].United European Gastroenterol J,2013,1(3):206-213.
[8]Spinelli A,Kotze PG.Anal fistula plug for perianal fistulising Crohn’s disease:an important trial for inflammatory Bowel disease surgeons[J].J Crohn’s Colitis,2016,10(2):125-126.
[9]田力,沈守荣,唐岸柳,等.1例复杂克罗恩病伴严重并发症患者的诊治[J].中南大学学报(医学版),2016,41(4):440-444.TIAN Li,SHEN Shourong,TANG Anliu,et al.Diagnosis and treatment of complicated Crohn’s disease with severe complications:A case report[J].Journal of Central South University.Medical Science,2016,41(4):440-444.
[10]Limura E,Giordano P.Modern management of anal fistula[J].World J Gastroenterol,2015,21(1):12-20.
[11]Yildirim N,G?kalp G,?ztürk E,et al.Ideal combination of MRIsequences for perianal fistula classification and the evaluation of additional findings for readers with varying levels of experience[J].Diagn Interv Radiol,2011,18(1):11-19.
[12]Yoshizakoa T,Wada A,Takahara T,et al.Diffusion-weighted MRI for evaluating perianal fistula activity:feasibility study[J].Eur J Radiol,2012,81(9):2049-2053.
[13]Horsth uis K,Lavini C,Bipat S,et al.Perianal Crohn’s disease:evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity[J].Radiology,2009,251(2):380-387.
[14]Karmiris K,Bielen D,Vanbeckevoort D,et al.Long-term monitoring of infliximab therapy for perianal fistulizing Crohn’s disease by using magnetic resonance imaging[J].Clin Gastroenterol Hepatol,2011,9(2):130-136.
[15]Tozer P,Ng SC,Siddiqui MR,et al.Long-term MRI-guided combined anti-TNF-alpha and th iopurine therapy for Crohn’s perianal fistulas[J].Inflamm Bowel Dis,2012,18(10):1825-1834.
[16]Krisztina BG,Willem B,Michael AK,et al.A global consensus on the classification,diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease[J].Gut,2014,63(9):1381-1392.
[17]Sahnan K,Pellino G,Adegbola SO,et al.Development of a model of th ree-dimensional imaging for the preoperative planning of Ta TME[J].Tech Coloproctol,2018,22(1):59-63.