CAJ | 학술논문

目的：肠道狭窄是克罗恩病的并发症之一，不同原因需采取不同的治疗方案。文中旨在运用磁共振弥散加权成像（ diffusion-weighted imaging ， DWI）对克罗恩病狭窄肠段进行研究，探讨该方法对于克罗恩病继发肠道狭窄性质的判定价值。方法收集2014年1月至同年6月，经南京医科大学第二附属医院肠镜检查、并病理确诊的31例克罗恩患者，男18例、女13例，年龄21～71岁，平均（38．90±13．65）岁。所有患者均接受3．0 T磁共振常规序列和弥散加权序列扫描。根据患者常规磁共振平扫的表现判断狭窄最严重的肠段，行弥散加权序列检查，并测量该病变段肠壁的表面扩散系数。所有患者在24 h内接受结肠镜检查。根据肠镜表现和病理结果将31例患者分为炎性狭窄组（ n＝21）和纤维性狭窄组（ n＝10）。观察组间表面扩散系数差异并计算截断点。结果炎性狭窄组病变段肠壁的表面扩散系数值为（1．01～1．83）×103mm2／s，平均（1．40±0．23）×103 mm2／s；纤维性狭窄组为（0．53～1．03）×103 mm2／s，平均（0．80±0．16）×103 mm2／s。组间比较差异有统计学意义（P＜0．05）。受试者工作特征曲线曲线下面积为0．981（95％CI 0．943～1．000），将1．11×103 mm2／s 作为截断点，对炎性狭窄判断的敏感性和特异性分别为90．5％和100％。结论由于不同病理成份对水分子运动的限制程度不一，故通过测量表面扩散系数可以得到定量参数，有助于DWI对克罗恩病继发肠道狭窄性质的鉴别诊断。
목적：장도협착시극라은병적병발증지일，불동원인수채취불동적치료방안。문중지재운용자공진미산가권성상（ diffusion-weighted imaging ， DWI）대극라은병협착장단진행연구，탐토해방법대우극라은병계발장도협착성질적판정개치。방법수집2014년1월지동년6월，경남경의과대학제이부속의원장경검사、병병리학진적31례극라은환자，남18례、녀13례，년령21～71세，평균（38．90±13．65）세。소유환자균접수3．0 T자공진상규서렬화미산가권서렬소묘。근거환자상규자공진평소적표현판단협착최엄중적장단，행미산가권서렬검사，병측량해병변단장벽적표면확산계수。소유환자재24 h내접수결장경검사。근거장경표현화병리결과장31례환자분위염성협착조（ n＝21）화섬유성협착조（ n＝10）。관찰조간표면확산계수차이병계산절단점。결과염성협착조병변단장벽적표면확산계수치위（1．01～1．83）×103mm2／s，평균（1．40±0．23）×103 mm2／s；섬유성협착조위（0．53～1．03）×103 mm2／s，평균（0．80±0．16）×103 mm2／s。조간비교차이유통계학의의（P＜0．05）。수시자공작특정곡선곡선하면적위0．981（95％CI 0．943～1．000），장1．11×103 mm2／s 작위절단점，대염성협착판단적민감성화특이성분별위90．5％화100％。결론유우불동병리성빈대수분자운동적한제정도불일，고통과측량표면확산계수가이득도정량삼수，유조우DWI대극라은병계발장도협착성질적감별진단。
[Abstract ] Objective Stenosis is a common complication of Crohn′s disease (CD), different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging(DWI) and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD (18 males and 13 females;mean age:38.90 ±13.65 years) were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient (ADC) of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group (n=21) and fibrotic group (n=10). We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were (1.01 ±1.83) ×103 mm2/s and (1.40 ±0.23) ×103 mm2/s, whereas (0.53 ±1.03) ×103 mm2/s and (0.80 ±0.16) ×103 mm2/s in the fibrotic group(P<0.05).The area under receiver operating characteristic curve was 0.981 (95%confidence interval 0.943-1.000), taking 1.11 ×103mm2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.