多层螺旋CT扫描在结肠癌术前分期中的应用  

The role of multi-slice CT in preoperative staging of colonic tumors

作　　者：张淼[1] 陈克敏[1] 赵泽华[1] 凌华威[1] 

机构地区：[1]上海第二医科大学附属瑞金医院放射科,200025

出　　处：《中华放射学杂志》2005年第5期505-509,共5页Chinese Journal of Radiology

摘　　要：目的评估结肠充气多层螺旋CT扫描(MSCT)在结肠癌术前分期中的应用价值.方法对36例临床高度怀疑或内镜活检证实的结肠癌患者进行MSCT检查,并利用工作站进行后处理以获取CT仿真内镜(CTVE)、多平面重建(MPR)、表面阴影成像(SSD)和透明显示(Raysum)图像,并结合横断面图像,进行肿瘤原发灶、淋巴结和转移情况分期(TNM分期),然后与术后病理对照.结果 MSCT术前 T分期敏感度为96.97%(32/33),阳性诊断准确度为87.88%(29/33);N分期灵敏度为73.91%(17/23),阳性诊断准确度为69.57%(16/23).转移淋巴结平扫CT值为(38.57±5.02)HU, 增强后CT值为(59.51±5.35)HU,差异有统计学意义(t=3.963,P<0.05);未发生转移的淋巴结平扫CT值为(29.16±3.66)HU,增强后CT值为(47.30±1.70)HU,差异有统计学意义(t=4.997,P<0.05).5例肝脏转移的患者均被CT检查发现.结论 MSCT可以有效地显示肿瘤的形态、大小和部位,确定肿瘤的侵犯范围、淋巴结转移和远处转移等,从而更准确地进行术前分期.不受肠管狭窄程度的限制,可以显示气体能够通过的任何部位,从而弥补了肠镜检查的不足.但术前对于早期病变T1～T3分期还有一定限度;N分期较困难,必须综合其大小、形态、密度及其生物学行为进行全面的判断.Objective To determine the accuracy of multi-slice CT pneumocolon in the staging of colonic carcinomas.Methods Thirty-six patients, who were strongly suspected to have colonic disorders, underwent CT pneumocolon before and after intravenous injection of iodinated contrast agent. CTVE, MPR, SSD, and Raysum images were then obtained by using 4 different softwares in workstation (ADW3.1). 33 positive cases were staged preoperatively according to TNM standard. All cases were proved by surgical or colonoscopic histology. Sensitivity and accuracy of MSCT were determined for the detection of cancers, lymph nodes, and metastases. Results MSCT pneumocolon examinations demonstrated 32 lesions, missing one case. Sensitivity and positive accuracy value for T staging were 96.97% (32/33) and 87.88% (29/33), respectively; Sensitivity and positive accuracy value for lymph node involvement were 73.91% (17/23) and 69.57% (16/23), respectively. The density of metastatic lymph node was higher than that of normal one. Five cases in M stage were all diagnosed correctly.Conclusion MSCT pneumocolon is a better method of depicting the colorectal carcinoma. It allows for accurate staging of the colorectal carcinoma, especially detecting the invasion of adjacent tissues and distant metastasis. However the value for early T staging in colorectal carcinoma and minute metastasis of lymph nodes is limited. It is helpful to combine all the findings of lymph nodes, including the size, density, and location, to make a correct diagnosis.

关 键 词：多层螺旋CT扫描 术前分期 结肠癌 诊断准确度 MSCT检查 CT仿真内镜 表面阴影成像 多平面重建 横断面图像 肿瘤原发灶 TNM分期 转移淋巴结 淋巴结转移 生物学行为 CT值 应用价值 结肠充气 内镜活检 病理对照 肝脏转移 侵犯范围 

分 类 号：R735.35[医药卫生—肿瘤]