64排螺旋CT在大肠腺瘤分型及癌变中的诊断价值  

64-slice Spiral CT in Grading of Colorectal Adenoma and Diagnosis of Adenocarcinoma

作　　者：潘冬梅[1] 范国华[1] 张维[1] 李洋[1] 

机构地区：[1]苏州大学附属第二医院影像科,江苏苏州215004

出　　处：《中国医学影像学杂志》2015年第5期364-368,共5页Chinese Journal of Medical Imaging

摘　　要：目的分析不同病理类型的大肠腺瘤的CT表现,探讨64排螺旋CT在大肠腺瘤分型及癌变中的诊断价值。资料与方法回顾性分析经手术病理证实的68例结直肠腺瘤患者的CT表现,包括病变的部位、大小、形态、与邻近结构的关系及增强扫描动脉期、静脉期、延迟期的强化程度,比较不同病理类型及分级的腺瘤增强扫描动脉期、静脉期、延迟期的CT差值(△CT值)。结果 68例中,绒毛状腺瘤16例,绒毛管状腺瘤42例,管状腺瘤10例。绒毛状腺瘤及绒毛管状腺瘤表现为宽基底、绒毛状,动脉期呈脑回状或树叶状强化,表面可见一层低密度黏液覆盖;管状腺瘤表现为窄基底、结节状,均匀强化。绒毛状腺瘤与管状腺瘤各期△CT值差异有统计学意义(t动脉期=2.56,P<0.05;t静脉期=3.22,P<0.05;t延迟期=2.48,P<0.05),绒毛状腺瘤与绒毛管状腺瘤、绒毛管状腺瘤与管状腺瘤各期△CT值差异无统计学意义(P>0.05)。癌变组病灶沿肠壁匍匐性生长、周围有肠系膜血管集群或淋巴结增大。无异型增生组与癌变组各期△CT值差异有统计学意义(t动脉期=2.49,P<0.05;t静脉期=2.69,P<0.05;t延迟期=2.75,P<0.05),无异型增生组与异型增生组、异型增生组与癌变组各期△CT值差异无统计学意义(P>0.05)。动脉期△CT值以50 HU为标准鉴别非癌变与癌变的敏感度、特异度分别为76.92%、70.91%。结论不同病理类型的大肠腺瘤及其癌变的CT表现具有一定的特征性,病灶的大小、形态、增强△CT值及病灶邻近情况对术前明确诊断及治疗具有重要价值。Purpose To evaluate 64-slice spiral CT in grading of colorectal adenoma and in the diagnosis of adenocarcinoma. Materials and Methods Sixty-eight cases of pathology confirmed colorectal adenoma were retrospectively reviewed to analyze CT performance including the location, size, shape and their relationship with adjacent structures and degree of enhancement in arterial, venous and delayed phase. The difference of CT attenuation value before and after enhancement（ △ CT value） in arterial, venous and delay phase of different pathological types and different levels of adenomas were compared. Results Among 68 lesions, 16 were villous adenomas, 42 were tubulovillous adenomas and 10 were tubular adenomas. Villous adenomas and tubulovillous adenomas were characterized by wide base, villous-like with gyral or frond pattern enhancement in arterial phase. There was a layer of low density mucus covering the surface. Tubular adenomas were featured as narrow base, nodular in shape with homogeneous enhancement. △ CT values in each phase between villous adenomas and tubular adenomas showed statistically significant difference（arterial phase t=2.56, P〈0.05; venous phase t=3.22, P〈0.05; delayed phase t=2.48, P〈0.05）, however no significant difference was shown between villous and tubule villous adenomas or between tubulovillous and tubular adenomas. Adenocarcinomas showed creeping-type growth along the intestinal wall with a cluster of vessels adjacent to the tumor or enlarged lymph nodes. △CT values in each phase between non-dysplasia group and carcinoma group showed statistically significant difference（arterial phase t=2.49, P〈0.05; venous phase t=2.69, P〈0.05; delayed phase t=2.75, P〈0.05）, however no significant difference was shown between non-dysplasia group and dysplasia group or between dysplasia group and carcinoma group. Using 50 HU of △CT value in artery phase as standard, the sensitivity and specificity for diagnosis of adenocarcinomas were 76.92% and 70.91%, respectively. Conclusion CT

关 键 词：肠肿瘤 腺瘤 腺癌 体层摄影术 螺旋计算机 癌前状态 病理学 外科 诊断 鉴别 

分 类 号：R735.34[医药卫生—肿瘤] R730.42[医药卫生—临床医学]