64排CT薄层及多平面重建技术对不同部位和不同病理分期结直肠癌的术前T分期  

Thin imaging and multiplanar reconstruction in 64-slice CT for preoperative T staging on different parts and various pathological staging of colorectal cancer

作　　者：姜军[1] 周纯武[1] 李颖[1] 蒋力明[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院影像诊断科,北京100021

出　　处：《中国医学影像技术》2009年第12期2154-2158,共5页Chinese Journal of Medical Imaging Technology

基　　金："十一五"国家科技及支撑课题(2007BAI05B05)

摘　　要：目的探讨CT薄层及多平面重建在不同部位和不同病理分期结直肠癌术前T分期中的价值。方法应用64排螺旋CT进行容积数据扫描163例结直肠癌患者,分别以层厚5 mm(间隔5 mm)及0.5 mm(间隔0.4 mm)重建出横断面图像及多平面重建图像(MPR),对病变进行部位及T分期评估。根据发病部位分成3组:Ⅰ组:直肠下段前壁或邻近齿状线;Ⅱ组:直肠下段后壁或侧壁;Ⅲ组:直肠中上段或结肠。将Ⅲ组病例按照术后病理分期分为4组:A组:Tis和T1;B组:T2(B1组:T2a,B2组T2b);C组:T3;D组:T4。对照术后病理结果分析不同部位、不同成像方法及不同病理分期进行T分期的准确率。结果5 mm对Ⅰ、Ⅱ、Ⅲ组T分期的诊断灵敏度分别为44.44%、61.54%和66.67%;0.5 mm分别为51.85%、61.54%和69.92%;MPR分别为51.85%、76.92%和78.86%。CT对Ⅰ组与Ⅲ组的诊断准确灵敏度存在显著差异(5 mmP=0.031、MPRP=0.004),Ⅲ组中MPR组优于5 mm和0.5 mm(P=0.008,P=0.019)。CT对Ⅲ组A、B、C、D4亚组的T分期诊断灵敏度如下:5 mm为53.85%、30.00%(B1组57.14%,B2组6.25%)、84.00%和60.00%;0.5 mm为76.92%、33.33%(B1组76.92%,B2组18.75%)、84.00%和60.00%;MPR分别为92.31%、53.33%(B1组78.57%,B2组31.25%)、86.67%和80.00%。CT对B2组的诊断灵敏度显著低于其他组,且大部分诊断错误病例为高估。结论CT对早期结直肠癌诊断具有良好的灵敏度、特异度和准确率。MPR可提高CT对中上段直肠及结肠肿瘤的诊断灵敏度。CT对直肠下段前壁或邻近齿状线的直肠癌的T分期灵敏度均较低,对T2b过高诊断是主要原因。Objective To explore the diagnostic value of thin image and multiplanar reconstruction（MPR） for preoperative T staging on different regions and various pathological staging of colorectal cancer.Methods A total of 163 colorectal cancer patients underwent 64-slice CT examination,then cross section image with thickness of 5 mm（5 mm interval） and 0.5 mm（0.4 mm interval） were reconstructed.The lesions were evaluated and T staged with 5 mm,0.5 mm and MPR image,respectively.Patients were divided according to the region of lesions： group Ⅰ .. the anterior wall of lower rectal or near dentate line; group Ⅱ ： the posterior or lateral wall of lower rectal; group Ⅲ ： upper middle rectal or clone. Patients in group Ⅲwere divided into 4 subgroups according to postoperative pathological staging： group A： Tis and Ⅱ; group B： T2 （B1： T2a; B2： T2b） ; group C： T3; group D： T4. The accurate diagnostic rates of different regions, different imaging techniques and different pathological staging were analyzed compared with postoperative pathological results. Results CT accurate T staging diagnostic rate for group Ⅰ, Ⅱ,Ⅲwas 44.44%, 61. 54% and 66.67% respectively with 5 mm; 51.85%, 61.54% and 69.92% respectively with 0.5 ram; 51.85%, 76.92% and 78.86% with MPR. There was significant difference of CT accurate diagnostic rates only between group Ⅰ and group Ⅲ（5 mm P=0. 031, MPR P=0. 004）. MRP was better then 5 mm and 0.5 mm only in group Ⅲ （P=0. 008, P=0. 019）. The sensibility of diagnostic T staging of A, B, C and D subgroup in group Ⅲwas as follows： 53.85%, 30.00%（B1： 57.14%0, B2： 6.25%）, 84.00% and 60.00% with 5 mm; 76.92%, 33.33%（B1： 76.92%, B2： 18.75%）,84.00% and 60.00% with 0.5 mm; 92.31%, 53.33% （B1： 78.57% B2： 31.25%）, 86.67% and 80.00% with MPR. CT accurate T staging diagnostic rate of subgroup B2 was significantly lower than those of other groups, and most of the errors were over valuated. Conclusion CT has good sensitivity, specificit

关 键 词：结直肠肿瘤 体层摄影术 X线计算机 多平面重建 T分期 

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