术前CT三维重建血管密度对结直肠癌淋巴结转移和远处转移的预测价值  

Predictive value of tumor vessel density from enhanced spiral CT scan for lymph node and distant metastasis of colorectal cancer

作　　者：景阳[1] 孙立波[1] 舒振波[1] 李永超[1] 丁大勇[1] 张惠茅[2] 薄丽华[3] 

机构地区：[1]吉林大学中日联谊医院胃肠外科,长春130033 [2]吉林大学中日联谊医院放射科,长春130033 [3]吉林大学中日联谊医院中心研究室,长春130033

出　　处：《中华胃肠外科杂志》2013年第5期448-450,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨术前64层三维增强CT测得的肿瘤血管密度（TVD）对结直肠癌淋巴结转移和远处转移的判断价值。方法回顾性分析吉林大学中日联谊医院胃肠外科2008年10月至2010年3月间经手术和术后病理证实的40例结直肠癌患者的临床资料。所有患者术前均通过64层增强三维CT重建肿瘤血管，并使用高清晰度彩色病理图文分析系统检测TVD值。以术后病理为判断淋巴结转移的金标准，以术中探查作为远处转移的金标准。分析增强CT及TVD检测值对淋巴结转移和远处转移的预测价值。结果CT判定淋巴结转移的敏感性、特异性和准确性分别为74．1％（20／27）、53．8％（7／13）和67．5％（27／40）。肿瘤血管三维成像后，淋巴结转移患者TVD值为0．070±0．046，明显高于无淋巴结转移者的0．037±0．013（P〈0．05）；远处转移患者TVD值为0．130±0．032，明显高于无远处转移者的0．049±0．030（P〈0．01）。结论术前64层三维增强CT所测得的TVD值可预测结直肠肿瘤淋巴结转移和远处转移。Objective To test whether the tumor vessel density （TVD） from the enhanced spiral CT can preoperatively predict nodal status and distant metastasis of colorectal cancer. Methods Forty cases of colorectal cancer patients who received surgical treatment were included in this study. The three dimensional tumor vessels were reconstructed by an enhanced CT 64-slice spiral CT and its AW4.4 image processing platform. The TVD was measured by the 1000 high-resolution color graphics pathological analysis system. The TVD level was compared between different tumor size, classification, and TNM stage. The postoperative pathological staging was taken as golden standard. Results The sensitivity, specificity and accuracy for direct prediction of lymph node metastasis by the enhanced CT 64 slice spiral CT was 74.1%（20/27）, 53.8%（7/13） and 67.5%（27/40） respectively. The TVD from the reconstructed three dimensional tumor vessels in the group with lymph node metastasis was significantly higher than that without metastasis（0.070~0.046 vs. 0.037~0.013, P〈0.05）. The TVD in the distant metastasis group was significantly higher than that without distant metastasis （0.130~0.032 vs. 0.049~0.030, P〈0.01）. No difference of TVD was found between different tumor size, invasion depth, and differentiation type. Conclusion TVD level from the reconstructed three dimensional tumor vessels can indicate lymph node and distant metastasis of colorectal cancer.

关 键 词：结直肠肿瘤 肿瘤血管密度 体层摄影术 X线计算机 淋巴结转移 远处 转移 

分 类 号：R735[医药卫生—肿瘤] R730[医药卫生—临床医学]