克罗恩病肠道纤维化的无创定量诊断研究进展

诊断学理论与实践››2025,Vol. 24››Issue (04): 383-392.doi:10.16150/j.1671-2870.2025.04.004

克罗恩病肠道纤维化的无创定量诊断研究进展

张平新¹^,², 杨洁^3a, 王杨迪^3b, 陈旻湖²^,^3a, 李雪华^3b, 毛仁^3a()

1.武汉大学中南医院消化内科，湖北武汉 430071
2.深圳前海泰康医院消化内科，广东深圳 518052
3.中山大学附属第一医院，a消化内科，b放射诊断科，广东广州 510080

收稿日期:2025-05-22修回日期:2025-07-10接受日期:2025-08-05出版日期:2025-08-25发布日期:2025-09-09
通讯作者:毛仁 E-mail：maor5@mail.sysu.edu.cn
基金资助:
国家重点研发计划(2023YFC2507300);国家自然科学基金(82222010);国家自然科学基金(81970483);广东省重点领域研发计划(2023B1111040003)

Research progress on noninvasive quantitative diagnosis of intestinal fibrosis in Crohn's disease

ZHANG Pingxin¹^,², YANG Jie^3a, WANG Yangdi^3b, CHEN Minhu²^,^3a, LI Xuehua^3b, MAO Ren^3a()

1. Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Hubei Wuhan 430071, China
2. Department of Gastroenterology, Shenzhen Qianhai Taikang Hospital, Guangdong Shenzhen 518052, China
3. Department of Gastroente-rology, 3b.Department of Radiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangdong Guangzhou 510080, China

Received:2025-05-22Revised:2025-07-10Accepted:2025-08-05Published:2025-08-25Online:2025-09-09

摘要/Abstract

摘要：

克罗恩病（Crohn's disease， CD）是一种病因复杂的慢性、非特异性肠道炎症性疾病，其在病程中常伴随肠道纤维化进展，最终可导致肠腔狭窄、梗阻及穿透等严重并发症。肠道纤维化的发生具有不可逆性，且对抗炎治疗反应有限。因此，对纤维化的早期识别和精准定量评估对于优化治疗策略、延缓疾病进展、减少手术风险及改善患者长期预后具有重要意义。近年来，随着影像技术的迅速发展，计算机断层扫描肠道成像（computed tomography enterography， CTE）、磁共振肠道成像（magnetic resonance enterography， MRE）、肠道超声（intestinal ultrasound， IUS）以及正电子发射体层摄影（positron emission tomography， PET）-CT/PET-MRE等多种无创检查手段在临床应用中不断成熟，通过整合结构参数、功能成像、弹性测量及影像组学-人工智能模型等多维手段，显著提升了肠道纤维化定量评估的效能与精度。本文将系统总结CD相关肠道纤维化定量影像评估技术的研究进展，旨在为CD纤维化的临床精准管理及新型抗纤维化治疗研究提供理论依据与实践参考。

关键词:克罗恩病,肠道纤维化,定量诊断,无创评估,影像学评估

Abstract:

Crohn's disease (CD) is a chronic, non-specific inflammatory bowel disease with complex etiology, often accompanied by progressive intestinal fibrosis during its course, which can ultimately lead to severe complications such as luminal stricture, obstruction, and fistula. The development of intestinal fibrosis is irreversible and shows limited response to anti-inflammatory therapies. Therefore, early identification and precise quantitative assessment of intestinal fibrosis are crucial for optimizing therapeutic strategies, delaying disease progression, reducing surgical risks, and improving long-term prognosis. In recent years, with the rapid development of imaging technologies, multiple noninvasive diagnostic modalities—including computed tomography enterography (CTE), magnetic resonance enterography (MRE), intestinal ultrasound (IUS), and positron emission tomography (PET)-CT/PET-MRE have become increasingly mature in clinical application. By integrating multidimensional approaches such as structural parameters, functional imaging, elastography, and radiomics-artificial intelligence models, the efficiency and accuracy of quantitative assessment of intestinal fibrosis have been significantly improved. This review systematically summarizes the research progress on quantitative imaging assessment techniques for CD-associated intestinal fibrosis,aiming to provide a theoretical basis and practical reference for the precise clinical management of CD fibrosis and the development of novel anti-fibrotic therapies.

Key words:Crohn's disease,Intestinal fibrosis,Quantitative diagnosis,Non-invasive assessment,Imaging evaluation

中图分类号:

R574.62
R445

张平新, 杨洁, 王杨迪, 陈旻湖, 李雪华, 毛仁. 克罗恩病肠道纤维化的无创定量诊断研究进展[J]. 诊断学理论与实践, 2025, 24(04): 383-392.

ZHANG Pingxin, YANG Jie, WANG Yangdi, CHEN Minhu, LI Xuehua, MAO Ren. Research progress on noninvasive quantitative diagnosis of intestinal fibrosis in Crohn's disease[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(04): 383-392.

图/表4

图1

图2

	检查前准备复杂程度*	检查耗时	检查成本*	实施难点	适用场景
CTE	4	1~2 h	3	·设备可及性 ·患者配合度和依从性	·评估肠道全局病变 ·术前精准评估纤维化程度
MRE	4	2~3 h	4	·设备可及性 ·患者配合度和依从性	·评估肠道全局病变 ·术前精准评估纤维化程度 ·有CTE检查禁忌
IUS	1	15~30 min	2	·检查实施者技术经验	·狭窄患者初步筛查 ·门诊检查 ·病情随访
PET-CT / PET-MRE	4	1~3 h	5	·设备可及性 ·患者配合度和依从性 ·检查实施者技术水平 ·检查成本	·术前精准分型 ·新药疗效评估 ·临床科研

表1

表2

CD肠道纤维化影像学定量评估指标及预测模型总结

作者（年份）	分类体系	样本量	预测参数	参考标准	纤维化分级	效能评估
作者（年份）	分类体系	样本量	预测参数	参考标准	纤维化分级	AUC	灵敏度	特异度
CTE
Huang, et al. （2025）^{[ 21 ]}	肠道纤维化诊断模型	训练集：6 验证集：6	·电子密度 ·HU值	组织病理学	模型概率 ≤0.484，无/轻度纤维化模型概率 >0.484，中/重度纤维化	0.828	77.3%	82.4%
Li, et al. （2021）^{[ 22 ]}	放射组学模型	训练集：98 验证集：114	影像学特征值	组织病理学	模型概率 ≤0.811，轻度纤维化模型概率 >0.811，中/重度纤维化	0.888	81.5%	93.9%
Meng, et al. （2022）^{[ 23 ]}	深度学习模型	训练集：159 验证集：153	·肠壁厚度 ·壁层分层 ·狭窄前扩张 ·管腔大小	组织病理学	模型概率 ≤0.623，轻度纤维化模型概率 >0.623，中/重度纤维化	0.828	78.0%	85.7%
Li, et al. （2021）^{[ 24 ]}	肠系膜爬行脂肪指数	训练集：91 验证集：30	肠系膜爬行脂肪指数（MFCI）	组织病理学	MCFI ≤ 3分,轻度纤维化 MCFI >3分,中/重度纤维化	0.799	92.3%	58.8%
Meng, et al. （2022）^{[ 25 ]}	列线图	训练集：91 验证集：83	·MFCI ·肠系膜水肿程度 ·病程	组织病理学	无/轻度纤维化中/重度纤维化	0.832	-	-
MRE
Coimbra, et al.（2022）^{[ 28 ]}	综合诊断模型	61	·表观扩散系数 ·磁共振活动指数 ·延迟强化增益	组织病理学	MRE纤维化评分 ≤2.1，轻度纤维化 MRE纤维化评分 >2.1，中/重度纤维化	0.910	68.1%	100%
Du, et al. （2021）^{[ 29 ]}	表观扩散丰度成像	训练集：31 验证集：9	表观扩散峰度	组织病理学	Kapp <0.775，无/轻度纤维化 Kapp ≥0.775，中/重度纤维化	0.896	95.9%	78.1%
Du, et al. （2020）^{[ 30 ]}	表观扩散丰度成像	训练集：31 验证集：9	·表观扩散峰度 ·非高斯分布的表观扩散系数	组织病理学	总分对应纤维化概率 ≤0.594，轻度纤维化总分对应纤维化概率 >0.594，重度纤维化	Harrell一致性指数0.901
Zhang, et al. （2019）^{[ 31 ]}	体素内不相干运动参数	95	体素微循环灌注分数（f）	组织病理学	f ≥ 0.33，轻中度纤维化 f < 0.33，重度纤维化	0.876	92.6%	82.4%
Huang, et al. （2018）^{[ 32 ]}	T2*WI成像	102	T2*WI值	组织病理学	T2WI ≥18.06 ms，轻度纤维化 T2WI < 18.06 ms，中度或重度纤维化	0.951	94.7%	78.3%
Jordi, et al. （2015）^{[ 33 ]}	动态对比增强成像	44	70 s至7 min增强增益百分比（%Gain）	组织病理学	%Gain ≤ 23.5%，无/轻度纤维化 %Gain > 23.5%，中重度纤维化	0.930	94.0%	89.0%
Li, et al. （2018）^{[ 35 ]}	磁化传递成像	训练集：97 验证集：18	磁化传递率（MTR）	组织病理学	MTR ≤ 0.71，无/轻度纤维化 MTR > 0.71，中重度纤维化	0.919	84.4%	90.0%
Zhang, et al. （2024）^{[ 36 ]}	放射组学模型	训练集：93 验证集：30	·T2WI ·增强T1WI ·DWI ·ADC ·MTI	组织病理学	模型概率 ≤ 0.36，无/轻度纤维化模型概率 > 0.36，中重度纤维化	0.930	84.0%	100%
IUS
Maconi, et al. （2003）^{[ 42 ]}	Maconi 评分	43	超声下肠壁回声形态	组织病理学	低回声模式：无/轻度纤维化，以炎症为主混合回声模式：中度纤维化，炎症和纤维化混合存在分层回声模式：中/重度纤维化，以纤维化为主	-	100%	63.3%
Rispo, et al. （2017）^{[ 45 ]}	Lèmann 指数	71	·肠壁厚度 ·壁层分层 ·狭窄前扩张 ·管腔大小	组织病理学	1 级：BWT > 3.0 mm，或节段性强化而无狭窄前扩张 2 级：BWT > 4.0 mm，或肠壁分层而无狭窄前扩张 3 级：BWT > 4.0 mm，管腔狭窄，且增厚肠管上方的肠袢呈液性扩张或有回声内容物填充	-	-	-
Chen, at al.（2018）^{[ 46 ]}	剪切波弹性成像（SWE）	35	SWE值	组织病理学	SWE值 > 22.55 kPa,重度纤维化 SWE值 ≤ 22.55 kPa,轻/中度纤维化	-	69.6%	91.7%
PET-MRE
Scharitzer, et al.（2023）^{[ 54 ]}	⁶⁸Ga-FAPI-PET/MRE	14	最大标准摄取值（SUVmax）	组织病理学	SUVmax ≤ 4.4，无/轻微纤维化 4.4 < SUVmax ≤ 7.5，轻/中度纤维化 SUVmax>7.5，重度纤维化	0.940	93.0%	83.0%

表2

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