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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） ›› 2019, Vol. 16 ›› Issue (12) : 949 -955. doi: 10.3877/cma.j.issn.1672-6448.2019.12.012

所属专题： 文献；

腹部超声影像学

超声造影定量分析评估克罗恩病炎症活动程度的应用价值
王韦力1, 程文捷2, 文艳玲2, 高翔3, 郅敏3, 余俊丽2, 陈瑶2, 刘小银2, 刘广健2,†()   
  1. 1. 510630　广州，中山大学附属第三医院超声科
    2. 510655　广州，中山大学附属第六医院超声科
    3. 510655　广州，中山大学附属第六医院消化内科
  • 收稿日期:2017-03-24 出版日期:2019-12-01
  • 通信作者: 刘广健

Contrast-enhanced ultrasound quantitative analysis for assessment of disease activity of Crohn′s disease

Weili Wang1, Wenjie Cheng2, Yanling Wen2, Xiang Gao3, Min Zhi3, Junli Yu2, Yao Chen2, Xiaoyin Liu2, Guangjian Liu2,†()   

  1. 1. Department of Ultrasound, the Third Affiliated Hospital of SunYat-Sen University, Guangzhou 510630, China
    2. Department of Ultrasound, the Sixth Affiliated Hospital of SunYat-Sen University, Guangzhou 510655, China
    3. Department of Gastroenterology, the Sixth Affiliated Hospital of SunYat-Sen University, Guangzhou 510655, China
  • Received:2017-03-24 Published:2019-12-01
  • Corresponding author: Guangjian Liu
  • About author:
    Corresponding author: Liu Guangjian, Email:
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引用本文：

王韦力, 程文捷, 文艳玲, 高翔, 郅敏, 余俊丽, 陈瑶, 刘小银, 刘广健. 超声造影定量分析评估克罗恩病炎症活动程度的应用价值[J]. 中华医学超声杂志（电子版）, 2019, 16(12): 949-955.

Weili Wang, Wenjie Cheng, Yanling Wen, Xiang Gao, Min Zhi, Junli Yu, Yao Chen, Xiaoyin Liu, Guangjian Liu. Contrast-enhanced ultrasound quantitative analysis for assessment of disease activity of Crohn′s disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(12): 949-955.

目的

探讨超声造影（CEUS）定量分析评估克罗恩病（CD）炎症活动程度的应用价值。

方法

回顾性分析2014年2月至8月于中山大学附属第六医院就诊或随访的55例经临床、内镜、病理综合诊断的CD患者。以血清超敏C反应蛋白（hs-CRP）水平为诊断金标准，评价能量多普勒（PDI）Limberg分级、CEUS增强模式及定量分析参数［峰值强度（PI）、上升时间（RT）、达峰时间（TTP）］评估CD炎症活动程度的价值。采用独立样本t检验比较炎症活动期与炎症非活动期CD患者CEUS定量分析参数PI、RT及TTP；以hs-CRP水平作为诊断金标准，分别绘制PDI技术、CEUS增强模式、CEUS定量分析参数PI、RT及TTP诊断CD炎症活动程度的受试者工作特征（ROC）曲线，并采用χ2检验比较曲线下面积。

结果

hs-CRP水平显示，本组55例CD患者中，炎症活动期39例，炎症非活动期16例。以hs-CRP水平作为诊断金标准，PDI技术诊断CD炎症活动程度的Youden指数为0.49，CEUS增强模式诊断CD炎症活动程度的Youden指数为0.25；炎症活动期CD患者PI高于炎症非活动期CD患者［（22.7±3.4）dB vs（18.5±3.7）dB］，而炎症活动期CD患者RT及TTP均短于炎症非活动期CD患者［（6.1±1.6）s vs（7.4±3.0）s，（7.5±1.9）s vs（9.3±2.9）s］，且差异均有统计学意义（t=-4.1，P<0.001；t=2.1，P<0.05；t=2.8，P<0.01）；ROC曲线显示，CEUS定量分析参数PI、RT、TTP诊断CD炎症活动期的阈值分别为19 dB、6.2 s、8.7 s，Youden指数分别为0.56、0.39和0.45；PDI技术、CEUS增强模式、CEUS定量分析参数PI、RT、TTP诊断CD炎症活动程度的曲线下面积分别为0.74、0.62、0.82、0.65、0.74。CEUS定量分析参数PI诊断CD炎症活动程度的曲线下面积大于CEUS增强模式诊断CD炎症活动程度的曲线下面积，且差异有统计学意义（P=0.03），而其余曲线下面积两两比较差异均无统计学意义。

结论

CEUS定量分析评估CD炎症活动程度的能力优于CEUS定性分析，与传统PDI Limberg分级方法无显著差异。且CEUS定量分析技术客观可靠，不易受检查者的主观影响，值得临床推广应用。

关键词: Crohn病, 超声检查, 造影剂
Objective

To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) quantitative analysis in assessing the disease activity of Crohn′s disease (CD).

Methods

From February to August 2014, 55 consecutive patients who were comprehensively confirmed to have CD by clinical, endoscopic, and pathologic evidence were prospectively evaluated. Using the concentration of high-sensitivity C-reactive protein (hs-CRP) as the reference standard, the diagnostic performance of power Doppler image (PDI) according to Limberg classification, the enhancement patterns on CEUS, and quantitative parameters including peak intensity (PI), rising time (RT), and time to peak (TTP) were analyzed and compared. Quantitative parameters between active and inactive CD patients were compared by the independent t-test. The receiver operating characteristic curve (ROC) of each parameter was analyzed, and the area under the ROC (AUROC) was compared by the χ2-test.

Results

There were 39 patients with active and 16 with inactive CD according to the level of hs-CRP. PDI according to Limberg classification had a Youden index of 0.49, while CEUS patterns had a Youden index of 0.25. Quantitative analysis showed higher PI and shorter RT and TTP in patients with active disease than in those with inactive CD (P<0.05). ROC analysis showed that the cutoff values in assessment of disease activity were: PI>19 dB, RT≤6.2 s, and TTP≤8.7 s. By using the quantitative parameters presented above as diagnostic standard, the Youden indexes were 0.56, 0.39, and 0.45, respectively. Pairwise comparisons showed that PI had higher efficiency in assessing the inflammatory activity of CD in comparison to qualitative analysis (P<0.05).

Conclusion

CEUS quantitative analysis performs better than qualitative analysis in the assessment of the activity of CD. Although the performance of CEUS quantitative analysis is equal to that of PDI, the former is more objective and should be recommended in clinical practice.

Key words: Crohn disease, Ultrasonography, Contrast media
图1 Limberg分级。图a为Limberg Ⅰ级：肠壁增厚，肠壁未探及血流信号；图b为Limberg Ⅱ级：肠壁增厚，能量多普勒示肠壁内点状或短条状血流信号；图c为Limberg Ⅲ级：肠壁增厚，能量多普勒示肠壁内长条状血流信号；图d为Limberg Ⅳ级：肠壁增厚，能量多普勒示与肠系膜相连的长条状血流信号
图2 超声造影增强模式分型。图a为肠壁呈低增强（A型），上图示造影剂注射后18 s，黏膜及黏膜下层呈低增强，下图示造影剂注射后21 s，黏膜及黏膜下层呈稍低-等增强，固有肌层无增强，本例患者PI=18.3 dB；图b为肠壁呈黏膜及黏膜下层高增强（B型）：上图示造影剂注射后20 s，黏膜及黏膜下层呈低增强，下图示造影剂注射后22 s，黏膜及黏膜下层呈稍高增强，固有肌层无增强，本例患者PI=23.5 dB；图c为肠壁呈由内向外全层增强（C型）：上图示造影剂注射后14 s，近肠腔侧的黏膜及黏膜下层先增强；中图示造影剂注射后17 s，黏膜及黏膜下层显著增强；下图示造影剂注射后24 s，包括固有肌层、浆膜层界面的全层肠壁均呈高增强，肠周组织亦可见增强；图d为肠壁呈由内向外全层增强（D型）：上图示造影剂注射后16 s，近系膜侧的固有肌层、浆膜层界面及肠周组织先增强，黏膜及黏膜下层呈不规则低增强；下图示造影剂注射后22 s，全层肠壁均呈高增强。白色箭头示黏膜及黏膜下层，黄色箭头示固有肌层；左图均为常规超声图，右图均为超声造影图
表1 PDI技术诊断CD炎症活动程度的价值（例）
Limberg分级 hs-CRP 合计
炎症活动期 炎症非活动期
Ⅲ~Ⅳ级 29 4 33
0~Ⅱ级 10 12 22
合计 39 16 55
表2 CEUS增强模式诊断CD炎症活动程度的价值（例）
CEUS增强模式 hs-CRP 合计
炎症活动期 炎症非活动期
B型＋C型 34 10 44
A型＋D型 5 6 11
合计 39 16 55
表3 炎症活动期与非活动期CD患者CEUS定量分析参数比较（±s）
组别 例数 PI（dB） RT（s） TTP（s）
炎症活动期 39 22.7±3.4 6.1±1.6 7.5±1.9
炎症非活动期 16 18.5±3.7 7.4±3.0 9.3±2.9
t值 ? -4.1 2.1 2.8
P值 ? <0.001 <0.05 <0.01
图3 能量多普勒技术、超声造影增强模式及定量分析参数诊断克罗恩病炎症活动程度的受试者操作特征曲线
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