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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (06) : 406 -410. doi: 10.3877/cma.j.issn.1672-6448.2016.06.002

所属专题： 文献；

腹部超声影像学

常规超声检查及超声造影在克罗恩病诊断中的应用价值
魏淑萍1, 杨斌1,†(), 徐超丽1, 李幼生2, 毛琦2, 傅宁华1, 田付丽1   
  1. 1. 210002　南京大学医学院附属金陵医院超声诊断科
    2. 210002　南京大学医学院附属金陵医院普通外科
  • 收稿日期:2015-11-23 出版日期:2016-06-01
  • 通信作者: 杨斌
  • 基金资助:
    南京军区南京总医院课题(2013007)

Application of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of Crohn′s disease

Shuping Wei1, Bin Yang1,†(), Chaoli Xu1, Yousheng Li2, Qi Mao2, Ninghua Fu1, Fuli Tian1   

  1. 1. Department of Ultrasound, , Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
    2. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
  • Received:2015-11-23 Published:2016-06-01
  • Corresponding author: Bin Yang
  • About author:
    Corresponding author: Yang Bin, Email:
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魏淑萍, 杨斌, 徐超丽, 李幼生, 毛琦, 傅宁华, 田付丽. 常规超声检查及超声造影在克罗恩病诊断中的应用价值[J/OL]. 中华医学超声杂志（电子版）, 2016, 13(06): 406-410.

Shuping Wei, Bin Yang, Chaoli Xu, Yousheng Li, Qi Mao, Ninghua Fu, Fuli Tian. Application of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of Crohn′s disease[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(06): 406-410.

目的

探讨常规超声检查及超声造影在克罗恩病（CD）诊断中的应用价值。

方法

2012年12月至2015年6月于南京大学医学院附属金陵医院超声诊断科行常规超声检查及超声造影的CD患者19例。所有患者均经内镜检查及手术病理结果证实。其中处于炎症活动期12例，缓解期7例。分析其常规超声检查及超声造影声像图特征，并根据时间-强度曲线得出达峰时间（TTP）及达峰强度（PI）。采用Wilcoxon秩和检验比较炎症活动期与缓解期CD患者TTP、PI差异。

结果

19例CD患者常规超声检查表现为受累肠管壁不同程度增厚，肠壁分层不清，肠管活动僵硬，肠壁彩色血流信号丰富。超声造影后12例炎症活动期CD患者中5例表现为黏膜下层普遍高增强，7例表现为由管壁内侧（黏膜层）开始往外侧的肠壁全层增强；7例缓解期CD患者中5例表现为管壁外侧往内侧的肠壁全层增强，2例表现为肠壁低或无增强。时间-强度曲线显示炎症活动期CD患者TTP为（8.33±0.92）s，缓解期CD患者TTP为（10.62±1.61）s，炎症活动期CD患者TTP早于缓解期CD患者，且差异有统计学意义（Z=-2.537，P<0.05）；炎症活动期CD患者PI为（27.67±1.61）dB，缓解期CD患者PI为（25.48±1.49）dB，炎症活动期CD患者PI高于缓解期CD患者，且差异有统计学意义（Z=-2.451，P<0.05）。

结论

常规超声检查及超声造影有助于CD的诊断，超声造影对CD病变活动性评价更具有特殊应用价值。

关键词: 超声检查, 造影剂, 克罗恩病, 诊断
Objective

To explore the value of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in the diagnosis of Crohn′s disease (CD).

Methods

From December 2012 to June 2015, totally 19 patients with CD were examined with conventional ultrasound and CEUS in Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University. All patients were confirmed by endoscope and surgical pathology, including 12 cases of active CD and 7 cases of quiescent CD. The characteristics were analyzed and the quantitative parameters of time-to-peak (TTP) and peek intensity (PI) were gained according to the time-intensity curve (TIC). The difference of TTP and PI between active CD and quiescent CD was compared by Wilcoxon rank sum test.

Results

In these 19 patients, conventional ultrasound revealed stiff and thickened bowel walls with loss of normal peristalsis, the layers had ill-de?ned internal margins, and color Doppler identified the increased vascularization in mural or extra-visceral. In CEUS, the enhancement patterns of submucosal prevalent enhancement (5 cases) and complete transmural enhancement starting from mucosa and involving the entire bowel wall (7 cases) were generally related to active CD (12 cases), while complete transmural enhancement starting from perivisceral vessels and involving the entire bowel wall (5 cases) and low or absent enhancement (2 cases) were generally related to quiescent CD (7 cases). The quantitative analysis of TIC showed patients with active CD presented a reduced TTP enhancement and an increased PI in comparison to patient with quiescent CD [(8.33±0.92) s vs. (10.62±1.61) s, (27.67±1.61) dB vs. (25.48±1.49) dB] , and there was statistically difference between them (Z=-2.537, -2.451, both P<0.05).

Conclusions

Conventional ultrasound and CEUS is useful in diagnosing CD. In addition, CEUS is valuable in the evaluation of CD activity.

Key words: Ultrasonography, Contrast media, Crohn disease, Diagnosis
图11，12 CD患者时间-强度曲线。图11、12　分别为炎症活动期、缓解期。示CD患者炎症活动期肠壁（白色曲线）达峰时间明显提前并且达峰强度高于缓解期（蓝色曲线为肠系膜组织）
表1 炎症活动期与缓解期CD患者TTP及PI比较（±s）
组别 例数 TTP（s） PI（dB）
活动期 12 8.33±0.92 27.67±1.61
缓解期 7 10.62±1.61 25.48±1.49
Z值 ? -2.537 -2.451
P值 ? <0.05 <0.05
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