Study On Diagnosis Of CT Enterography In Inflammatory Bowel Disease And Clinical Application Of Crohn’s Disease Activity Evaluation

Part one Diagnostic value of CT enteroclysis in inflammatory boweldiseaseObjective: to analyze the clinical and angiographic features of CT intestinal inflammatory bowel disease, and to evaluate the value of CT enterography in the diagnosis of IBD.Methods: the retrospective analysis method, methods from 2012 March to 2015 3 months in our hospital after clinical, colonoscopy or surgery pathology diagnosis of IBD patients in 71 cases, including 51 cases of patients with Crohn’s disease, ulcerative colitis(UC colitis, UC) from 20 patients, all patients underwent examination of CTE. 1, the clinical characteristics, analysis of IBD; 2, all kinds of IBD CTE performance analysis, including intestinal lesions(intestinal wall thickening, thickening, abnormal enhancement, serosa involvement), lesions, lesions involving the way, intestinal morphology and intestinal.Results: 1, the clinical symptoms of tenesmus, mucusbloodandpus in patients with UC, compared with CD, the difference was statistically significant c2=24.079,P<0.05 and c2=14.771,P<0.05); 2, CD and UC showed thickening of the intestinal wall thickening, but in different ways, the CD demonstrated asymmetrical thickening, UC showed thickening of symmetry CD and UC lesions; intestinal mucosa showed abnormal enhancement(c2=0.485,P>0.05); CD predilection for the small intestine, cecum, and UC occurred in the rectum, sigmoid and descending colon; CD showed multiple segmental involvement, while UC showed continuous intestinal wall involvement; bowel stiff and the disappearance of colonic pouch tips for patients with UC; serosal infiltration, cellulitis, abdominal fistula / perianal abscess, showed patients with CD.Conclusion: CTE can clearly show the lesion and intestinal IBD performance, has important value in the clinical diagnosis of IBD.Part two Application of CT small bowel imaging in the assessment ofthe activity of Crohn’s diseaseObjective: To investigate and analyze the diagnostic value of CT in the diagnosis of Crohn’s disease activity.Methods: a retrospective analysis of our hospital in 2010 May 5 months to 2015, through clinical, colonoscopy or surgery and pathology of patients with Crohn’s disease in 80 cases, all patients underwent Harvey-Bradshow CD index score(CDAI)(see Table 1) were calculated CDAI value, CADI value > 4 minutes CD in the active stage, CADI is less than or equal to 4 points that Cd in remission. After calculation of the active phase CD was 46 cases, the remission stage CD was 34 cases, all patients underwent CTE examination. Analysis of the following features of CD patients CTE: lesions of the bowel wall thickness; intestinal wall in arterial phase and portal venous phase CT value; bowel wall enhancement(homogeneous enhancement, hierarchical reinforcement); intestinal morphology; extraintestinal manifestations(comb), mesenteric density increased, abdominal lymph nodes, cellulitis, sinus, fistula abdominal abscess. Application SPSS16.0 statistical software, the intestinal wall thickness, arterial phase and portal venous phase CT values of three quantitative indicators was evaluated by ROC curve analysis and identify diagnosis of Cd in active stage and remission stage of critical value; all the significant characteristics of CTE to establish a scoring system, each of which supports CD activity in the period of the feature set to + 1 points, and support CD remission period feature set to- 1, according to this principle to calculate the total score of each patient, then by ROC curve to select optimal cut-off value of diagnosis of CD activity and remission stage and calculation the critical value in the diagnosis of sensitivity and specificity.Results:(1) in active CD patients with lesions of the bowel wall thickness, arterial phase and portal venous phase CT values were significantly higher than those in remission period; active CD performance for stratified sample of bowel wall enhancement, remission of CD showed homogeneous enhancement; shorten the mesangial margin and free edge of diverticula of the formation of prompt, c2=13.196, P < 0.05 for remission of CD patients(2=13.196); active CD performance mesenteric density increased, cellulitis, abdominal lymph node enlargement and comb sign(2) the ROC curve analysis of the area under the curve of the intestinal wall thickness, arterial phase and portal venous phase CT value were 0.993 and 0.937, 0.946, sign the best don’t diagnostic critical value was: 6.005 mm, 81.91 HU, 88.26HU;(3) ROC curve analysis of score system in the differential diagnosis of CD in active and remission stage critical value of the fraction of 0.5, and the sensitivity was 93.5%, specificity was 97.1%, under the ROC curve area is 0.995.Conclusion:(1) active CD bowel wall thickness, arterial phase and portal venous phase CT values were significantly higher than those in remission period; active CD intestinal wall performance like hierarchical strengthening, mesenteric density increased, cellulitis, abdominal lymph node enlargement and comb sign, alleviate CD homogeneous enhancement, pseudodiverticulum formation of submucosal fat deposition, shorten the mesangial margin, free edge.(2) the sensitivity of in the use of the scoring system for CD in the active stage or in the remission stage was 93.5%, which indicated that the small intestine CT angiography could be mentioned.The accuracy of the diagnosis of CD activity is high, and it can guide the clinical treatment.