The Clinical Study Of Crohn's Disease By Multi-Slice CT

ObjectivesTo measure and analyze the wall thickness of Crohn's disease with MSCT,using the normal wall thickness as a control;then,to compare the wall thickness of active and chronic stage,to study the feasibility of evaluating the severity of CD by the wall thickness.Materials and MethodsA retrospective analysis was performed.68 CD cases(36 males and 32 females)in Shandong provincial hospital,from June 2011 to December 2015,were all diagnosed through an integrated approach including clinical applications,medical imaging,endoscopy,surgery and pathology examination.MSCT examination was performed in 44 cases.20 cases were selected as control which no lesion was found in small intestine,ileocecum or ascending colon after MSCT examination.Two doctors analyzed the CT manifestation of the lesions on Syngo Acquisition Workplace post-processing workstation.The cases with lesions were divided into three groups: small intestine group,ileocecum group,and colon group.The wall thickness of each lesion was measured.The cases as control were divided into three groups: small intestine group,ileocecum group,and colon group,the wall thickness was measured respectively(A review of the imaging before measurement was performed to avoid the influence of peristaltic waves).The difference of intestinal wall thickness between the lesion groups and the control groups was compared with nonparametric test;and then,by dividing the cases with lesion into two groups: active stage group and chronic stage group,the intestinal wall thickness difference between the two groups was compared with the same method.Numerical statistics were perfo-rmed by using mean +/-standard deviation.Results1.In the 44 cases of CD patients with MSCT examination,all the pathological bowel wall were found being thickened,and all the pathological bowel lumen were found being narrowed,among which 10(22.7%)cases was suffered with a single lesion,34(77.3%)cases were suffered with multiple lesions,Lesions in the small intestine were found in 35(79.5%)cases,and in the ileocecum were found in 32(72.7%)cases,and in the colon were found in 20(45.5%)cases,lesions involving the small intestine,the ileocecum and the colon were found in the 14(31.8%)cases,involving the small intestine and the ileocecum were found in 11(25%)cases,involving the small intestine and the colon was found in 1(2.3%)case,involving the ileocecum and the colon were found in 2(4.5%)cases.26(59%)cases showed multiple layers or single layer enhancement,moderately or significantly,18(41%)cases with intestinal wall single-layer slightly enhanced or no obvious enhancement.Most pathological intestinal wall can find visible ulceration,5(7.3%)cases with fistula or abscess,7(10%)cases with intestinal obstruction,24(54.5%)cases with comb sign,21(47.7%)cases with creeping fat,some patients can be found enlarged lymph nodes in the abdominal and retroperitoneal cavity with the largest of 1.36 cm.2.According to the CD active and chronic stage grouping,there are 26(59.1%)cases in active stage,and there are 18(40.9%)cases in chronic stage.3.Analysis the intestinal wall thickness,the pathological intestinal wall thickness range from 0.38 cm to 1.42cm(average 0.68cm),the control intestinal wall thickness range from 0.06 cm to 0.14cm(average 0.10cm),the pathological intestinal wall is obviously thicken than the control intestinal wall;the average intestinal wall thickness of the small intestine,the ileocecum and the colon in the active stage were 0.766±0.128?0.834±0.218?0.773±0.149 cm respectively,the average chronic intestinal wall thickness of the small intestine,the ileocecum and the colon in the chronic stage were 0.467±0.052?0.511±0.048?0.512±0.054 cm respectively.The wall thickness of the activity lesions were thicken than the wall thickness of the chronic lesions.ConclusionsMSCT examination can clearly show the conditions of the intestinal wall,the lumen and the extramural complications of the CD patients;MSCT can measure the intestinal wall thickness precisely using a variety of post-processing techniques to reform the thin layer image at any level;The intestinal wall thickness can be used as a image feature for the diagnosis of CD,at the same time,the activity of the lesions can be judged according to the pathological intestinal wall thickness,and also the quantitative research can be achieved.For the reexamination patients,no arterial phase scanning but just plain scanning and venous phase scanning can be performed to reduce the radiation dose of the patients.