低张水灌肠多层螺旋CT对大肠癌的诊断价值  

Value of Multi-slice Spiral CT with Water Enema for the Diagnosis of Colorectal Carcinoma

作　　者：刘玉金[1] 陈克敏[1] 刘林祥[2] 吕守敬[2] 邵岩[2] 

机构地区：[1]上海第二医科大学附属瑞金医院放射科 [2]泰山医学院附属医院

出　　处：《临床放射学杂志》2006年第1期54-58,共5页Journal of Clinical Radiology

摘　　要：目的探讨低张水灌肠多层螺旋CT(MSCT)对大肠癌的诊断价值。资料与方法对60例内镜诊断或怀疑大肠癌的患者行低张水灌肠MSCT三期增强扫描,以横断面为主,结合多平面重组(MPR),观察肿瘤的部位、大小、形态及周围侵犯、转移情况,作出诊断及TNM分期,并与术后病理对照。结果MSCT检出了全部53例大肠癌,敏感性为100%,补充了内镜漏诊的1例多发大肠癌,纠正了1例内镜误诊的淋巴瘤;TNM分期的准确性为83.0%(44/53),T、N、M分期准确性分别为94.3%(50/53)、86.8%(46/53)、98.1%(52/53)。结论低张水灌肠MSCT可以有效地显示大肠癌的部位、大小和形态,能较准确地确定中晚期大肠癌的侵犯范围和肝脏转移,TNM分期准确性较单层螺旋CT有明显提高;增强门脉期或平衡期对TNM分期是必要的;MSCT对大肠癌T1～T3分期还缺乏可靠的诊断标准;对淋巴结转移的判断仍存在假阳性和假阴性;MPR是横断面的有益补充;MSCT是内镜检查的重要补充。Objective To assess the value of multislice spiral CT（MSCT） with water enema for the diagnosis of colorectal carcinoma. Materials and Methods 60 cases diagnosed by colonoscoy or suspected colorectal carcinoma were examined by three phase enhanced MSCT scan with axial and MPR images to evaluate location, size, shape, surrouding structure and metastasis, the results on CT were compared with those of surgical and pathological examination in all cases. Results All the 53 colorectal carcinoma were demonstrated clearly by MSCT and the sensitivity was 100% ; 44 of 53 cases were correctly staged with TNM and the accuracy was 83.0%, misdiagnosis of colorectal carcinoma was diagnosed by MSCT, and misdiagnosis of lyphoma was revised by MSCT. The accuracy of T, N and M was 94.3%（50/53）, 86.8%（46/53） and 98.1% （52/53） respectively. Conclusion MSCT is an excellent modality of depicting the colorectal carcinoma, It can display the tumor＇s location, size and shape efficiently, the extension to adjacent tissues and the metastasis to liver can be assessed exactly. MSCT is more accurate than spiral CT in the staging of TNM, portal phase is essential to the staging of TNM, There are false negative and false positive in the N staging. MPR images are valuable for depicting the colorectal carcinoma, MSCT examination is complementary for conventional colonoscopy,

关 键 词：肿瘤分期 直肠肿瘤 体层摄影术 X线计算机 

分 类 号：R735.34[医药卫生—肿瘤] R814.42[医药卫生—临床医学]