直肠充气MSCT检查对直肠癌术前分期的诊断价值  

Value of Rectum-Aerated MSCT for Preoperative Staging of Rectal Cancer

作　　者：张银旭[1] 张俊华[1] 雷振[2] 张军[2] 

机构地区：[1]辽宁医学院附属第一医院普通外科,辽宁锦州121001 [2]辽宁医学院附属第一医院放射科,辽宁锦州121001

出　　处：《中国普外基础与临床杂志》2011年第8期902-906,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨直肠内充气MSCT检查在直肠癌术前肠系膜浸润及淋巴结转移分期中的临床诊断价值。方法选择2010年1月至2010年7月期间辽宁医学院附属第一医院68例经手术病理证实的直肠癌患者,术前行直肠内充气MSCT检查,以术后病理结果作为金标准,比较直肠内充气MSCT在诊断肠系膜浸润及淋巴结转移方面的准确性、敏感度、特异度、阳性预测值及阴性预测值。结果直肠内充气MSCT扫描患者的直肠及乙状结肠充分扩张,直肠周围脂肪间隙与相对较高密度的肠壁及极低密度肠腔对比清晰。直肠内充气MSCT对直肠癌肠系膜浸润Ⅰ、Ⅱ、Ⅲ度的准确性分别为92.6(63/68)、91.1%(62/68)及95.6%(65/68),敏感度分别为91.2%(31/34)、85.0%(17/20)及92.9%(13/14),特异度分别为94.1%(32/34)、93.8%(45/48)及96.3%(52/54),阳性预测值分别为93.9%(31/33)、85.0%(17/20)及86.7%(13/15),阴性预测值分别为91.4%(32/35)、93.8%(45/48)及98.1%(52/53);直肠癌肠系膜淋巴结转移N0、N1、N2分期的准确性分别为92.6%(63/68)、85.3%(58/68)及92.6%(63/68),敏感度分别为86.2%(25/29)、90.0%(27/30)及66.7%(6/9),特异度分别为97.4%(38/39)、81.6%(31/38)及96.6%(57/59),阳性预测值分别为96.2%(25/26)、79.4%(27/34)及75.0%(6/8),阴性预测值分别为90.5%(38/42)、92.1%(35/38)及95.0%(57/60)。结论直肠内充气MSCT扫描能够清晰显示直肠癌直肠系膜浸润深度,对肠系膜淋巴结转移术前N分期诊断与病理N分期具有较高的敏感度和特异度,在直肠癌术前分期中有重要的应用价值,可作为术前影像学评估的常规手段,为制定个体化的治疗方案提供指导。Objective To investigate the value of rectum-aerated MSCT examination in diagnosis of mesorectal infiltration of rectal cancer and lymph node metastasis staging.Methods From January 2010 to July 2010,the data of 68 patients with rectal cancer confirmed by pathology were analyzed in the First Affiliated Hospital of Liaoning Medical University.All the patients underwent rectum-aerated MSCT preoperatively and postoperative pathology was taken as the gold standard for evaluation of the accuracy,sensitivity,specificity,positive or negative predictive values of MSCT in diagnosis of mesorectal infiltration and lymph node metastasis.Results In rectum-aerated MSCT scanning,rectum and sigmoid colon was fully expanded,perirectal fat space was clear between perirectal fat space and relatively high density rectal wall and very low density enteric cavity.For mesorectal infiltration of degree Ⅰ,Ⅱ,and Ⅲ,the accuracies were 92.6%（63/68）,91.1%（62/68）,and 95.6%（65/68）,respectively;sensitivities were 91.2%（31/34）,85.0%（17/20）,and 92.9%（13/14）,respectively;specificities were 94.1%（32/34）,93.8%（45/48）,and 96.3%（52/54）,respectively;positive predictive values were 93.9%（31/33）,85.0%（17/20）,and 86.7%（13/15）,respectively;negative predictive values were 91.4%（32/35）,93.8%（45/48）,and 98.1%（52/53）,respectively.For lymph node metastasis in N0,N1,and N2,the accuracies were 92.6%（63/68）,85.3%（58/68）,and 92.6%（63/68）,respectively;sensitivities were 86.2%（25/29）,90.0%（27/30）,and 66.7%（6/9）,respectively;specificities were 97.4%（38/39）,81.6%（31/38）,and 96.6%（57/59）,respectively;positive predictive values were 96.2%（25/26）,79.4%（27/34）,and 75.0%（6/8）,respectively;negative predictive values were 90.5%（38/42）,92.1%（35/38）,and 95.0%（57/60）,respectively.Conclusions Rectum-aerated MSCT scaning can clearly show the depth of rectal carcinoma infiltration in the mesorectum,and N staging of mesorectal lymph node metastasis of MSCT has

关 键 词：直肠肿瘤 直肠系膜 体层摄影术/X线计算机 N分期 浸润程度 

分 类 号：R735.37[医药卫生—肿瘤]