A Study On The Assessment Of Crohn 's Disease Activity And The Regression Mathematical Model Of Differential Diagnosis Of Intestinal

Objective: To investigate and analyze the value of spectral CTenterography in the evaluation of Crohn’s disease activity by logisticregression method.Methods: The spectral CT enterography data from a cohort of140Corhn’s disease patients from May2010to September2013, whowere confirmed by clinical, double balloon endoscopy andhistopathology were analyzed retrospectively.83cases werediagnosed as active and57cases were diagnosed as inactive by theCDEIS evaluation. The parameters for differentiating active CDpatients from inactive CD patients were screened, which including theunivariable below:1. bowel thickness of the terminal ileum;2. CT valueof the bowel wall in AP and PVP;3. relative contrast enhancement ofthe bowel wall in AP and PVP;4.comb sign score in AP and PVP;5.type of enhancement pattern;6.morphology of the bowel wall;7.extra-luminal manifestations;8. iodine concentration in AP and PVP.SPSS for Windows version16.0(Chicago, IL) software was used toanalyze the data and screen for parameters that were valuable for the differential diagnosis. Better univariable was screened by Receiveroperating characteristic (ROC) analysis. Then, parameters withstatistical significance were further analyzed by multivariable logisticregression. ROC analysis was performed to obtain the predictivediagnosis point and assess the diagnostic efficacy of regressionmathematical model in discriminating active CD from inactive CDpatients. The area under the ROC curve, sensitivity, specificity,accuracy, positive predictive value and negative predictive value of themathematical regression model were evaluated.Results:1. the bowel thickness, CT value of the bowel wall, relativecontrast enhancement of the bowel wall, comb sign score and iodineconcentration in AP and PVP of the active CD patients were muchhigher than that of inactive CD patients (P＜0.05);2. active CDpatients manifest submucosal edema and extra-luminal exudation (P＜0.05); inactive CD patients manifest mural homogenous enhancementand sumucosal fibro-fatty infiltration (P＜0.05);. pseudosacculation ofantimesenteric border in inactive CD patients was significantly higherthan those in active CD patients (P＜0.05);.3. the area under the ROCcurve of the quantitative variables was0.993、0.969、0894、0.972、0.922、0.999、0.998、0.913and0.974,respectively;4. the spectral CT enterography parameters helpful in differentiating active CD frominactive CD include bowel thickness, mural homogenous enhancementand the iodine concentration in PVP by multivariable logistic regressionanalysis. The area under the ROC curve of the regressionmathematical model established by using these spectral CTenterographic parameters were0.961, sensitivity, specificity, accuracy,positive predictive value and negative predictive value of themathematical model were95.8%、98.2%、96.4%、97.5%、93.3%,respectively and a predictive boundary value of0.753wasobtained by ROC curve analysis.Conclusion:1. bowel thickness, CTvalue of the bowel wall and combsign score in AP and PVP, iodine concentration in PVP were betterquantitative univariables;2.the accuracy of the regressionmathematical model established by using the spectral CTenterographic parameters was96.4%, which suggests that spectral CTenterography can help improve the accuracy in assessment of CDactivity, thus enabling selection of the most appropriate treatment(medical management or intervention) for an improved outcome. Objective: To investigate and evaluate the values of clinical and CTenterographic manifestations in the differential diagnosis between CDand ITB.Methods: Clinical and CT enterographic manifestations of a cohortof141cases of Crohn’s disease and47cases of intestinal tuberculosisfrom May2008to September2013, who were confirmed by clinical,endoscopy and histopathology were retrospectively reviewed byfollowing predertermined criteria. All the patients underwent CTenterography examination. The clinical parameters for differentiatingCD from ITB were analyzed and screened, which including theunivariable below:1. demographic features;2. clinical features;3.laboratory features; the CT enterographic parameters fordifferentiating CD from ITB were analyzed and screened, whichincluding the univariable below:1.locations of involvement;2. skiplesions;3. tThickness of bowel wall;4. type of enhancement pattern5.morphology of involved bowel segments;6. features of lymph nodes;7.peritoneal chages;8. extra-luminal manifestations;9. extra-luminal complications. SPSS for Windows version16.0(Chicago, IL) softwarewas used to analyze the data and screen for parameters that werevaluable for the differential diagnosis. Parameters were screened bylogistic regression analysis and the regression equation (mathematicalmodel) was established. Furthermore, the diagnostic efficacy ofscreened parameters was analyzed by regression equation(mathematical model) and receiver operating characteristic curve.A predictive diagnosis point of the regression mathematical model indiscriminating CD from ITB was obtained. The area under the ROCcurve, sensitivity, specificity, accuracy, positive predictive value andnegative predictive value of the mathematical regression model wereevaluated.Results: by the multivariable double regression analysis,1. the clinicalfeatures helpful in differentiating CD from ITB were hematochezia,perianal disease, purified protein derivative skin test, occurrence ofascites, pulmonary tuberculosis, and night sweats. hematochezia andperianal disease were indicative of CD, while positive purified proteinderivative skin test, occurrence of ascites, pulmonary tuberculosis, andnight sweats favor the diagnosis of ITB. The sensitivity, specificity,accuracy, positive predictive value, and negative predictive value of regression mathematical model established by clinical features were94.3,80.4,91.0,93.7, and82.6%, respectively. A predictive diagnosispoint of the clinical regression mathematical model in discriminatingCD from ITB was0.806and the area under the ROC curve was0.916.Involvement of the left colon, asymmetric pattern of involvement,abscess, comb sign, distribution of the lymph nodes along the rightcolic artery, contracture of ileocecal valve, fixed patulous ileocecalvalve and lymph nodes with central necrosis. Involvement of the leftcolon, asymmetric pattern of involvement and abscess, comb signwere helpful for the diagnosis of CD, while distribution of the lymphnodes along the right colic artery, contracture of ileocecal valve, fixedpatulous ileocecal valve and lymph nodes with central necrosis favorthe diagnosis of ITB. The sensitivity, specificity, accuracy, positivepredictive value, and negative predictive value of regressionmathematical model established by CT enterographic parameters were96.5,93.6,95.7,97.8, and89.8%, respectively. A predictive diagnosispoint of the clinical regression mathematical model in discriminatingCD from ITB was0.682and the area under the ROC curve was0.986.Conclusion:1. in our study, two diagnostic mathematical modelsbased on selected valuable clinical and CT enterographic parameters have been established by logistic regression. Development of thesemathematical modelswould improve the sensitivity, specificity, andaccuracy in differentiating CD from ITB;2.the accuracy of CTenterographic regression model in our investigation was95.7%whichindicated that in the diagnosisflow sheet of differentiating CD and ITB,CTE should be considered as the first modality.