胶囊内镜与小肠CT成像在小肠克罗恩病诊断中的应用价值
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摘要
背景:小肠克罗恩病(CD)是影像学检查的难点。近年来,胶囊内镜被广泛应用于诊断小肠CD。目的:探讨胶囊内镜与小肠CT成像(CTE)在小肠CD临床诊断中的应用价值。方法:回顾性研究2014年10月—2018年4月同济大学附属第十人民医院收治的28例小肠CD患者,比较胶囊内镜与CTE的病变检出率和诊断准确性。结果:胶囊内镜与CTE总体病变检出率无明显差异(96. 4%对85. 7%,P> 0. 05),但胶囊内镜对小肠CD的诊断准确性优于CTE(89. 3%对42. 9%,P <0. 05),尤其是对空肠病变的诊断(96. 4%对21. 4%);两者对回肠病变的检出率无明显差异(96. 4%对78. 6%,P>0. 05)。CTE在病变定位以及发现肠外病变、结肠病变方面优于胶囊内镜。两者联合应用,对小肠CD的诊断准确性可达100%。结论:胶囊内镜对小肠CD的病变检出率与CTE相当,诊断准确性则明显优于CTE,尤其是对于空肠病变。两者联合应用在小肠CD的临床诊断中具有重要应用价值,值得进一步推广。
Background: Crohn's disease( CD) of small intestine is a difficult issue in imaging examination. In recent years,capsule endoscopy( CE) has been widely used in diagnosis of CD in small intestine. Aims: To assess the value of CE and CT enterography( CTE) for clinical diagnosis of small intestinal CD. Methods: Data of 28 cases of small intestinal CD who underwent CTE and CE at the Tenth People 's Hospital of Tongji University from Oct. 2014 to Apr. 2018 were analyzed retrospectively. The detection rate and diagnostic accuracy of CE and CTE were calculated and compared.Results: There was no significant difference in overall detection rate between CE and CTE( 96. 4% vs. 85. 7%,P >0. 05); but the diagnostic accuracy of CE for small intestinal CD was significantly higher than that of CTE( 89. 3% vs.42. 9%,P < 0. 05),especially for jejunal lesions( 96. 4% vs. 21. 4%). The performance of CE and CTE for detection of ileal lesions was similar( 96. 4% vs. 78. 6%,P > 0. 05). CTE is superior to CE in location and finding extraintestinal and colonic lesions. The diagnostic accuracy of combined use of CE and CTE for small intestinal CD was up to 100%.Conclusions: For diagnosis of small intestinal CD,the detection rate of CE for intestinal lesions is equal to that of CTE,while its diagnostic accuracy is superior to CTE,especially for jejunal lesions. Combined use of these two techniques is of great importance for clinical diagnosis of small intestinal CD and worthy to be used increasedly.
Background: Crohn's disease( CD) of small intestine is a difficult issue in imaging examination. In recent years,capsule endoscopy( CE) has been widely used in diagnosis of CD in small intestine. Aims: To assess the value of CE and CT enterography( CTE) for clinical diagnosis of small intestinal CD. Methods: Data of 28 cases of small intestinal CD who underwent CTE and CE at the Tenth People 's Hospital of Tongji University from Oct. 2014 to Apr. 2018 were analyzed retrospectively. The detection rate and diagnostic accuracy of CE and CTE were calculated and compared.Results: There was no significant difference in overall detection rate between CE and CTE( 96. 4% vs. 85. 7%,P >0. 05); but the diagnostic accuracy of CE for small intestinal CD was significantly higher than that of CTE( 89. 3% vs.42. 9%,P < 0. 05),especially for jejunal lesions( 96. 4% vs. 21. 4%). The performance of CE and CTE for detection of ileal lesions was similar( 96. 4% vs. 78. 6%,P > 0. 05). CTE is superior to CE in location and finding extraintestinal and colonic lesions. The diagnostic accuracy of combined use of CE and CTE for small intestinal CD was up to 100%.Conclusions: For diagnosis of small intestinal CD,the detection rate of CE for intestinal lesions is equal to that of CTE,while its diagnostic accuracy is superior to CTE,especially for jejunal lesions. Combined use of these two techniques is of great importance for clinical diagnosis of small intestinal CD and worthy to be used increasedly.
引文
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2 Marmo R,Rotondano G,Piscopo R,et al. Meta-analysis:capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases[J]. Aliment Pharmacol Ther,2005,22(7):595-604.
3 中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见(2018年,北京)[J].中华消化杂志,2018,38(5):292-311.
4 中华医学会消化病学分会胃肠动力学组;中华医学会消化病学分会胃肠功能性疾病协作组.中国功能性消化不良专家共识意见(2015年,上海)[J].中华消化杂志,2016,36(4):217-229.
5 中华医学会消化病学分会胃肠功能性疾病协作组;中华医学会消化病学分会胃肠动力学组.中国肠易激综合征专家共识意见(2015年,上海)[J].中华消化杂志,2016,36(5):299-312.
6 刘红春,张希德.消化系统肠道疾病[M]//陈灏珠.实用内科学. 15版.北京:人民卫生出版社,2017:1565-1566.
7 Van de Bruaene C,De Looze D,Hindryckx P. Small bowel capsule endoscopy:Where are we after almost 15 years of use?[J]. World J Gastrointest Endosc,2015,7(1):13-36.
8 Raptopoulos V,Schwartz RK,McNicholas MM,et al.Multiplanar helical CT enterography in patients with Crohn’s disease[J]. AJR Am J Roentgenol,1997,169(6):1545-1550.
9 Ilangovan R,Burling D,George A,et al. CT enterography:review of technique and practical tips[J]. Br J Radiol,2012,85(1015):876-886.
10 Lee SS,Kim AY,Yang SK,et al. Crohn disease of the small bowel:comparison of CT enterography, MR enterography,and small-bowel follow-through as diagnostic techniques[J]. Radiology,2009,251(3):751-761.
11 中华医学会消化内镜学分会.中国胶囊内镜临床应用指南[J].胃肠病学,2014,19(10):606-617.
2 Marmo R,Rotondano G,Piscopo R,et al. Meta-analysis:capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases[J]. Aliment Pharmacol Ther,2005,22(7):595-604.
3 中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见(2018年,北京)[J].中华消化杂志,2018,38(5):292-311.
4 中华医学会消化病学分会胃肠动力学组;中华医学会消化病学分会胃肠功能性疾病协作组.中国功能性消化不良专家共识意见(2015年,上海)[J].中华消化杂志,2016,36(4):217-229.
5 中华医学会消化病学分会胃肠功能性疾病协作组;中华医学会消化病学分会胃肠动力学组.中国肠易激综合征专家共识意见(2015年,上海)[J].中华消化杂志,2016,36(5):299-312.
6 刘红春,张希德.消化系统肠道疾病[M]//陈灏珠.实用内科学. 15版.北京:人民卫生出版社,2017:1565-1566.
7 Van de Bruaene C,De Looze D,Hindryckx P. Small bowel capsule endoscopy:Where are we after almost 15 years of use?[J]. World J Gastrointest Endosc,2015,7(1):13-36.
8 Raptopoulos V,Schwartz RK,McNicholas MM,et al.Multiplanar helical CT enterography in patients with Crohn’s disease[J]. AJR Am J Roentgenol,1997,169(6):1545-1550.
9 Ilangovan R,Burling D,George A,et al. CT enterography:review of technique and practical tips[J]. Br J Radiol,2012,85(1015):876-886.
10 Lee SS,Kim AY,Yang SK,et al. Crohn disease of the small bowel:comparison of CT enterography, MR enterography,and small-bowel follow-through as diagnostic techniques[J]. Radiology,2009,251(3):751-761.
11 中华医学会消化内镜学分会.中国胶囊内镜临床应用指南[J].胃肠病学,2014,19(10):606-617.