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。
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 胃
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病
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
选择题答案:
-
True
-
False
-
False
-
False
-
Ileum and colon
-
Active Crohn’s disease
-
Both of the above
-
2 L
-
Portal venous phase
Findings and Diagnosis
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。
-
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
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Radiation enteritis 放射性肠炎
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Lymphoma 淋巴瘤
Crohn’s disease
Key Points
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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。
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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。
-
Early: Hyperplasia of lymphoid tissue, obstructive lymphedema
早期:淋巴组织增生、阻塞性淋巴水肿。
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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。
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Fistula 肠瘘
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Obstruction 梗阻
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Perforation 穿孔
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Increased risk of malignancy 恶性肿瘤的发生率增加
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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。
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。