The Application Of CTE Scoring System In Diagnosis Of Crohn’s Disease And Intestinal Tuberculosis

Objective:(1)To explore the value of computed tomographic enterography(CTE) in the diagnosis and differential diagnosis of Crohn’s disease(CD) and Intestinal tuberculosis(ITB).(2)Attempt to establish the CTE scoring method of CD to observe the feasibility of CTE score, compared with the result of endoscopic and clinical scores based on the same case group.(3)Set a comprehensive scoring system including clinical, endoscopic and CTE combining with indicators of statistical significance. Observe the effectiveness of each rating system and explore the clinical value of CTE grading index, compared with the clinical and endoscopic scoring system.Methods(1)84 patients of CD or ITB(61 patients of CD and 23 patients of ITB) diagnosed by clinical and pathological were collected from 2010 to 2015 in the first affiliated hospital of Anhui medical university. The clinical, endoscopic and CTE indicators were sorted and retrospectively analyzed.(2)The indicators of statistical significance in endoscope, clinical and CTE were found out, excluded the indicators which had a large controversy and no statistical significance according to clinical and radiograph reading experience.(3)Every index was scored according to the specific degrees and rate for the patient with CD and ITB.Calculate the score of clinical,endoscopic,CTE and the integrated scoring system.Given score to each indicator according to the degree of specificity. Calculated the score of CD and ITB respectively then got the comprehensive scores.(4)Draw the ROC curve, comparing the sensitivity and specificity of several different method to observe the effectiveness of integrated scoring system.Results(1) Among the clinical indexes,diarrhea and the history of anal lesions had statistical significance for diagnosis of CD; night sweats, strong positive PPD and pulmonary tuberculosis had statistical value which provided evidence for ITB diagnosis;(2)Among the endoscope indexes, skip lesions and longitudinal ulcers had statistical significance for diagnosis of CD; annular ulcer, fixed patulous ileocecal valve and the affected bowels<4 present statistical value which provided evidence for ITB diagnosis;(3) In the CTE indexes, involvements in jejunum, skip lesions,intestinal wall of mesentery thickening,intestinal wall hierarchical reinforcement,fistula,pseudosacculation of antimesenteric border,comb sign,occlusion of ileocecal valve,intestinal adhesion had statistical difference between the two groups which was of value for the diagnosis of CD; contralateral intestinal wall of mesentery thickening,contracture of ileocecal valve, or fixed patulous ileocecal valve,lymph nodes with central necrosis,and lymph nodes mainly distributing along the right colic artery had statistical difference between the two groups which was of value for the diagnosis of ITB.(4)The area of the integrated scoring system under the ROC curve was the highest, the sensitivity and specificity was higher than that of the simple clinical or endoscopy scoring system.Conclusion CTE has significant value for CD diagnosis,combined application of multiple signs is conducive to the differential diagnosis of CD and ITB. The combination of multiple features is more helpful for the differential diagnosis of CD and ITB.