【双语病例】克罗恩病的影像表现

History

A 46-year-old man presents with chronic abdominal pain and diarrhea.

Images from CT enterography are shown below.

46岁男性,慢性腹痛腹泻。

下图示CT肠道扫描图像。

【双语病例】克罗恩病的影像表现

【双语病例】克罗恩病的影像表现

【双语病例】克罗恩病的影像表现

1.There is segmental mucosal hyperenhancement(节段性粘膜强化).

True

False

2.There is an enterocolic fistula(小肠结肠瘘).

True

False

3.There is a mesenteric abscess(肠系膜脓肿).

True

False

4.There is small-bowel submucosal fat deposition(小肠粘膜下脂肪积聚).

True

False

5.Which bowel loops demonstrate abnormal findings?

哪部分肠管显示异常?

Jejunum 空肠

Ileum 回肠

Stomach

Colon 结肠

Ileum and colon 回肠和结肠

6.What do the above findings suggest?

以上表现提示为下列哪项诊断?

Active Crohn’s disease 活动性Crohn’s

Chronic fibrosing Crohn’s disease 慢性Crohn’s病纤维化

Active ulcerative colitis 活动性溃疡性结肠炎

Giardiasis 贾第虫病

Yersiniosis 耶尔森菌病

Additional Questions

7.What are the key differences between oral contrast agents for CT enterography versus conventional CT for the evaluation of inflammatory bowel disease?

口服造影剂CT肠道扫描与传统的CT扫描对肠道感染性疾病诊断有什么不同?

Lower density to allow visualization of mucosal enhancement

肠道内低密度有利于显示粘膜的强化。

Larger administered volume for adequate small-bowel distension

口服大量造影剂有助于小肠肠管适度扩张。

Both of the above

8.Which of the following total volumes of oral contrast is most appropriate for CT enterography?

CT肠道扫描口服造影剂最合适的剂量是多少?

500 mL

2 L

10 L

Volume of contrast does not affect evaluation

9.Which of the following phases of enhancement is optimal for evaluating Crohn’s disease activity?

增强扫描哪一期最适合评价Crohn’s病的活动性?

Arterial phase

Portal venous phase

Delayed phase

Phase of enhancement does not affect appearance of findings related to Crohn’s

【双语病例】克罗恩病的影像表现

【双语病例】克罗恩病的影像表现

选择题答案:

  1. True

  2. False

  3. False

  4. False

  5. Ileum and colon

  6. Active Crohn’s disease

  7. Both of the above

  8. 2 L

  9. Portal venous phase

【双语病例】克罗恩病的影像表现

Findings and Diagnosis

CT enterography

There are findings of active Crohn’s disease with mucosal hyperemia and perienteric fat stranding involving a segment of distal ileum and also the ascending colon (best see on coronal images). There is also prominence of vasa recta. There are no strictures, fistulas, or other findings to suggest superimposed fibrotic disease. The use of a neutral contrast agent (VoLumen) allows for optimal evaluation of mucosal changes.

图像示粘膜充血,提示Crohn’s病,主要累及升结肠和部分回肠。直小血管增粗。未见明显狭窄、瘘管等纤维化征象。口服中性造影剂有助于显示粘膜的改变。

Differential Diagnosis

  • Crohn’s disease Crohn’s病

  • Infection 感染性病变

  • Ulcerative colitis 溃疡性结肠炎

  • Ischemia 局部缺血

  • Radiation enteritis 放射性肠炎

  • Lymphoma 淋巴瘤

Diagnosis

Crohn’s disease

【双语病例】克罗恩病的影像表现

Key Points

Pathophysiology 病理生理学

  • Dysregulated recurrent inflammation, which can involve any portion of the gastrointestinal (GI) tract.

    反复感染、功能失调。可发生于消化道任何部分。

  • Pathophysiology is not completely elucidated; potential contributions from immunologic, genetic, environmental, infectious, and nutritional risk factors.

    其病理生理学尚不完全确定,可能由免疫学、基因、环境、感染因素、营养因素共同造成。

Phases of disease

  • Early: Hyperplasia of lymphoid tissue, obstructive lymphedema

    早期:淋巴组织增生、阻塞性淋巴水肿。

  • Intermediate: Transmural extension into mucosa and submucosa

    中期:病变累及粘膜和粘膜下层。

  • Advanced: Transmural extension to serosa and beyond

    进展期:病变累及浆膜层,并可能向肠外侵犯。

Complications 并发症

  • Fistula 肠瘘

  • Obstruction 梗阻

  • Perforation 穿孔

  • Increased risk of malignancy 恶性肿瘤的发生率增加

  • Sites of disease: Most commonly involves distal/terminal ileum (95%) and proximal colon (25%), but can manifest at other sites along the entire GI tract.

    好发位置:回肠末段(95%)及结肠近段(25%),也可发生于消化道其他位置。

Epidemiology 流行病学

  • Younger patients, typically 15 to 25 years old at diagnosis

    多发生于年轻患者,15-25岁。

  • More common in Caucasians

    多发生于白种人。

  • Increased risk with smoking history

    吸烟史可增加患病几率。

Imaging Feature

Protocol 方法

  • Low-density, neutral oral contrast agents such as VoLumen (0.1% barium mixed with sorbitol).

    口服低密度中性对比剂(VoLume)。

  • Larger volume of oral contrast than conventional CT to promote optimal bowel distension.

    相对于传统CT,口服大量造影剂有助于充盈肠管。

Findings

Active disease 活动性病变:

  • Mural hyperenhancement — segmental bowel involvement

    节段性肠壁强化

  • Mural stratification

    肠壁分层

  • Mural thickening

    肠壁增厚

  • Inflammatory mesenteric fat stranding

    肠系膜脂肪炎性病变、呈索条样

  • Engorged vessels

    血管充盈

Fibrostenosing disease 纤维性狭窄:

  • Submucosal fat deposition

    粘膜下脂肪积聚

  • Target or double halo sign

    靶征或双晕征

  • Luminal narrowing without acute inflammatory changes

    管腔狭窄,但无急性炎性改变

Penetrating disease 穿通性病变

  • Sinus tract formation

    窦道形成

  • Fistulization with surrounding structures

    周围瘘管形成

  • Fluid collections

    液体积聚

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