结构分析电子清肠X线断层结肠成像术检测结直肠平坦型病变  

Fecal-tagging computed tomographic colonography with structure-analysis electronic cleansing for detection of colorectal flat lesions

作　　者：许永华[1] 蔡文立[2] Nappi J Yoshida H 

机构地区：[1]上海市徐汇区中心医院放射科,200030 [2]美国哈佛医学院附属麻省总医院放射科

出　　处：《中华消化杂志》2009年第1期21-24,共4页Chinese Journal of Digestion

摘　　要：目的评价结构分析电子清肠软件应用于粪便标记三维X线断层结肠成像术（SAEC-3DCTC）检测结直肠平坦型病变的可行性和检出敏感度，并与Viatronix三维CT结肠成像（V3DCTC）和无电子清肠的二维CT结肠成像（2DCTC）比较。方法40例经CT结肠成像（CTC）检查的患者发现69个结直肠平坦型病变。结肠镜检查证实后，将这些病例分别独立进行SAEC-3D、V3D和2DCTC研究分析其检出敏感度。以结肠镜观察为金标准，结直肠平坦型病变定义为病变高度≤2mm或小于其宽度的1/2。结果69个结直肠平坦型病变中，直径2～3mm27个、4～6mm28个、7～9mm11个、≥10mm3个。SAEC-3DCTC的结直肠平坦型病变检出敏感度为51％（35／69），明显高于V3DCTC的32％（22／69）和2DCTC的29％（20／69）（P〈0．05）；SAEC3D、V3D和2DCTC对不位于结肠黏膜皱襞的平坦型病变检出敏感度分别为61％（23／38）、45％（17／38）和42％（16／38），高于对位于结肠黏膜皱襞内的平坦型病变检出敏感度的39％（12／31）、16％（5／31）和13％（4／31）。这三种CTC方法均未检出所有8个位于盲肠的病变（直径2～9mm）。除盲肠病变外，SAEC3DCTC对直径≥4mm平坦型病变的检出敏感度达84％（31／3F）。结论结构分析电子清肠软件应用于粪便造影剂标记3DCTC检测直径≥4mm结直肠平坦型病变可达到较高的敏感度；而且对不位于结肠黏膜皱襞的病变检出敏感度高于位于结肠黏膜皱襞的病变。盲肠平坦型病变可能是CTC的盲区。Objective To evaluate the feasibility and sensitivity of the 3D-reading of fecaltagging computed tomographic colonography （CTC） with a novel structure-analysis electronic cleansing （SAEC） in detecting colorectal flat lesions in comparison with a prospective 3D reading with Viatronix colon system （V3D） and 2D reading without electronic cleansing （2D）. Methods Forty CTC cases with flat lesions were retrospectively observed. The subjects from a multicenter clinical trial underwent cathartic bowel preparation with orally administrated barium-based fecal tagging. Sixty-nine flat lesions were confirmed using colonoscopy and histopathology as a reference standard. The results from SAEC reading were compared with those of prospective V3D and 2D readings. Results Overall detection sensitivity with SAEC was 51% （35/69）, which was statistically higher than that of 32% （22/69） and 29% （20/69） with V3D and 2D readings, respectively （P〈0.05）. The sensitivities in detecting not-on-fold flat lesions were 61% （23/38）, 45% （17/38）, and 42% （16/38） with SAEC, V3D, and 2D readings, respectively; whereas those of on-fold flat lesions were 39% （ 12/31 ）, 16 （5/31）, and 13% （4/31）, respectively. None of the eight flat lesions （2-9 mm） at cecum was detected by any of the three reading methods. Excluding the flat lesions at cecum, the sensitivity with SAEC for detecting flat lesion ≥4 mm increased to 84% （31/37）. Conclusions The fecal-tagging CTC with structure-analysis electronic cleansing could yield a high sensitivity for detecting flat lesions ≥4 mm. The not-on-fold flat lesions were detected with higher sensitivity than on fold flat lesions. Cecum may be a blind segment in the detection of flat lesions.

关 键 词：结肠疾病 盲肠疾病 结肠镜检查 计算机体层摄影 

分 类 号：R686[医药卫生—骨科学]