直肠周围间隙淋巴结转移的术前MSCT评估  

Preoperative MSCT Evaluation of Mesorectal Lymph Node Metastases

作　　者：周国兴[1] 郝楠馨[1] 张蕾[1] 诸静其[1] 潘海虹[1] 王军臣[2] 卢爱国[3] 

机构地区：[1]同济大学附属东方医院放射科,上海市即墨路150号上海200120 [2]同济大学附属东方医院病理科,上海市即墨路150号上海200120 [3]同济大学附属东方医院普外科,上海市即墨路150号上海200120

出　　处：《中国医学计算机成像杂志》2010年第1期25-30,共6页Chinese Computed Medical Imaging

摘　　要：目的:分析直肠周围间隙淋巴结转移的多层CT(MSCT)表现,探讨CT诊断直肠癌淋巴结转移(N分期)的价值。方法:术前行盆腔MSCT检查的154例直肠癌病例,均行全直肠系膜切除术,对直肠周围间隙淋巴结进行病理检查,采用双盲法,记录每枚淋巴结的CT表现,包括淋巴结短轴直径、边缘、密度、分布方式。结果:以手术病理为标准,直肠周围间隙淋巴结CT检出率为86.3%(471/546),病理共检出直肠周围间隙淋巴结546枚,CT检出481枚,其中471枚(阳性172枚,阴性299枚)淋巴结与病理相匹配。CT诊断直肠周围间隙淋巴结转移的各种判断标准(淋巴结大小、边缘、密度、分布方式)的敏感性分别为83.1%、72.2%、70.1%、73.5%,特异性分别为80.5%、85.1%、82.4%、75.1%。CT显示的淋巴结大小、边缘、密度、分布方式的差异与阳性率有显著相关性,P<0.005。结论:直肠周围间隙淋巴结有良性和恶性淋巴结,综合分析淋巴结大小、形态、密度及分布对诊断直肠周围间隙淋巴结转移有很大帮助。Purpose： To analyze the appearances of mesorectun in MSCT images, and to investigate the role of MSCT in diagnosis of lymph node metastases（ N staging） in rectal carcinoma.Methods： One hundred and fifty - four patients who had undergone total mesoreetal excision（TME） for rectal carcinoma were enrolled in this study after preoperative CT examination. The positive - nodes were considered on the basis of pathological examination . The characteristics of each detectable node（LN） were recorded by two radiologists, blinded for the histological results for the following aspects： Short- axis diameter, margin, density, location and distribution of LN within the mesorectum. Results： Of all, 86.3% （471/546） mesorectal lymph nodes were showed by CT, 471 nodes （299 benign, 172 malignant）could be matched exactly with nodes found on pathologic findings. The diameters, margin , density, location and distribution of LN within the mesorectum showed significant correlation with the node - positivity, P 〈 0. 005 . The sensitivity of each diagnostic criterion was： 83.1% for diameter, 72.2% for margin, 70.1% for density and 73.5% for distribution. The specificity was： 80.5% for diameter, 85.1% for margin, 82.4% for density, 75.1% for distribution. Conclusion： It was probably helpful to improve the diagnosis of mesorectal lymph node metastases by considering the size, margin, density, location and distribution of the lymph nodes.

关 键 词：直肠肿瘤 淋巴结 体层摄影术 X线计算机 

分 类 号：R816.5[医药卫生—放射医学] R735.37[医药卫生—临床医学]