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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (02) : 172 -176. doi: 10.3877/cma.j.issn.2095-2015.2024.02.014

综述

伪膜性结肠炎的CT表现及鉴别诊断
孙兆男1, 何江凯1, 黄文鹏2, 胡晓煜1, 黄勇1, 王霄英1,()   
  1. 1. 100034 北京大学第一医院医学影像科
    2. 100034 北京大学第一医院核医学科
  • 收稿日期:2023-09-12 出版日期:2024-04-01
  • 通信作者: 王霄英
  • 基金资助:
    首都卫生发展科研专项基金(2020-2-40710)

CT findings and differential diagnosis of pseudomembranous colitis

Zhaonan Sun1, Jiangkai He1, Wenpeng Huang2, Xiaoyu Hu1, Yong Huang1, Xiaoying Wang1,()   

  1. 1. Department of Radiology, Peking University First Hospital, Beijing 100034, China
    2. Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
  • Received:2023-09-12 Published:2024-04-01
  • Corresponding author: Xiaoying Wang
引用本文:

孙兆男, 何江凯, 黄文鹏, 胡晓煜, 黄勇, 王霄英. 伪膜性结肠炎的CT表现及鉴别诊断[J]. 中华消化病与影像杂志(电子版), 2024, 14(02): 172-176.

Zhaonan Sun, Jiangkai He, Wenpeng Huang, Xiaoyu Hu, Yong Huang, Xiaoying Wang. CT findings and differential diagnosis of pseudomembranous colitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(02): 172-176.

难辨梭菌是伪膜性结肠炎(PMC)的最主要致病菌。肠道菌群失调时,难辨梭菌增殖并释放大量毒素,导致PMC。基于近期抗生素使用史、腹泻、检出难辨梭菌病原体或毒素可确诊。CT可辅助评估病变范围及严重程度。PMC与其他病因致结肠炎的CT表现有一定重叠,但一些图像特征有助于区分上述疾病。本文综述了PMC的影像学特征及鉴别诊断。

Clostridium difficile is the primary pathogenic bacterium associated with pseudomembranous colitis (PMC). During an imbalance in the gut microbiota, Clostridium difficile proliferates and releases a large amount of toxins, leading to PMC. Diagnosis can be confirmed based on recent antibiotic use, diarrhea, and detection of Clostridium difficile pathogens or toxins. CT can assist in evaluating the extent and severity of the lesions. The CT manifestations of PMC overlap to some extent with other causes of colitis, but certain imaging features can help differentiate these conditions. This article provides a comprehensive review of the imaging features and differential diagnosis of PMC.

图1 伪膜性结肠炎患者平扫CT冠状位图像注:CT示盲肠、升结肠、横结肠肠壁弥漫增厚,伴有腹水,其中升结肠黏膜及黏膜下层呈典型结节样肿胀(箭头)。
图2 伪膜性结肠炎患者增强CT延迟期轴位图像注:CT示结肠脾曲明显增厚,增强扫描可见分层样强化,呈"靶征"。
图3 伪膜性结肠炎患者增强CT动脉晚期冠状位图像注:CT示横结肠黏膜明显强化(箭头),与低密度水肿带(虚箭)相间分布,形成"手风琴征"。横结肠肠腔萎陷,强化的黏膜相贴,形成"鱼骨征"。
表1 伪膜性结肠炎的诊断要点及鉴别诊断
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