Research On The Diagnostic Value Of Comprehensive Scoring System For The Crohn’s Disease Involving The Colon

Objective 1.To analyze the imaging characteristics and diagnostic value of multi-slice CT enterography(CTE) for Crohn disease(CD) involving the colon,and design CTE score for the diagnosis of CD.2.To explore the efficacy of Comprehensive scoring system for the diagnosis of CD involving the colon.3.Compare the diagnostic capacity of Comprehensive scoring system and endoscopic scoring system,clinical,endoscopic scoring system in CD involving the colon.4.To analyze the indicators of clinical, endoscopic,histology and MSCTE which could help identify CD and ITB.Methods Clinical, endoscopic,histological and CTE data of 237 patients who suspected CD attending in our hospital at a period of January 2009 to February 2014 were collected,all patients follow-up time more than one year,excluded diagnosis except CD 8 patientss,the diagnosis is not clear 11 patients,31 patients who were lost,18 patients had bowel resection historyor or incomplete data,169 cases met the diagnostic criteriaof CD.85 patients of CD involving the colon has been put into the study finally.and the data of 33 patients with intestinal tuberculosis(ITB) as a control at the same period were selected.1.The information of CD and ITB patients need to formulated into a clinical data investigation and registration form, which register all of patients’ Demographic data, clinical data and treatment during the hospital stay, and Inviting experienced endoscopic and radiological experts to assess the colonoscopy and CTE features without knowing the diagnosis.2. Focus on selected parameters of CTE which was helpful to distinguish CD and ITB,the specificity of the selected features was calculated.Based on the principle of Clinical, endoscopic scoring system,the parameters of CTE which had diagnostic value were given to score.3. Summarized the features of clinical, endoscopic histology and CTE of CD and ITB patients.Assessing the diagnostic value of CD of Clinical,endoscopic scoring system, Endoscopic scoring system and Diagnostic criteria of WHO.4.Comprehensive scoring system included clinical endoscopic scoring system and CTE score.Drawing ROC curve and to obtain diagnosis cutoff value of CD.5.Compare the diagnostic yield and diagnostic consistency of four diagnostic methods,The capacity of three scoring systems in diagnosing CD involving the colon was evaluated,using the receiver operating characteristic curve and the area under the curve.Results The analysis of CTE imaging showed that mural stratification enhancement,thickening obviously of the membrane margin and comb sign occurred more frequently in CD than in ITB and that lymph node calcification or central necrosis was more frequently found in ITB than in CD.The results of logistic regression analysis showed thatcomb sign(OR=6.624,95%CI:1.339~32.766,P<0.05) was an independent predictor of diagnosis of CD. CTE score:mural stratification enhancement(+1),thickening obviously of the membrane margin(+1),comb sign(+2),lymph node calcification or central necrosis(-3).Diagnosis rate of Comprehensive scoring system,Clinical,endoscopic scoring system, Endoscopic scoring system and WHO diagnostic criteria for diagnosis of CD were 78.4%,60.8%,43.2%,18.9% respectively.Four kind of diagnosis rates were compared by pairwise(P<0.05).The diagnostic consistency of Comprehensive system was the highest. The areas under ROC curves of Comprehensive scoring system,Clinical,endoscopicscoring system and Endoscopic scoring system were 0.924,0.864 and 0.719 respectively(P<0.05),the Youden index of them were 0.747,0.571 and 0.358 respectively.Among the three systems,the diagnostic capability of Comprehensive scoring system was the best.CD patients were younger than ITB,the incidence rates of diarrhea,perianal disease,C-reaction protein more than 30mg/l,involvement of more than four intestinal segments,longitudinal ulcers,mural stratification enhancement,thickening obviously of the membrane margin and comb sign in CD were higher than that in ITB; the incidence rates of history of abenteric tuberculosis, the positive rates of PPD and T-SPOT,transverse ulcers and lymph node calcification or central necrosis in ITB were higher than that in CD(P<0.05).Conclusions 1.Primary establish CTE score for the diagnosis of CD involving the colon.2.The diagnostic performance of Comprehensive scoring system was better than that of Clinical,endoscopic scoring system and Endoscopic scoring system.3.Younger patients,diarrhea,perianal disease,C-reaction protein more than 30mg/l,involvement of more than four intestinal segments,longitudinal ulcers,mural stratification enhancement,thickening obviously of the membrane margin and comb sign may contribute to diagnose CD;history of abenteric tuberculosis, PPD and T-SPOT positive,transverse ulcers and lymph node calcification or central necrosis may contribute to diagnose ITB.