多层螺旋CT对粘液性与非粘液性结直肠癌的鉴别诊断价值  

Differentiation between Mucinous and Nonmucinous Colorectal Carcinoma Based on Multi-slice Spiral CT Findings

作　　者：邓祥春[1] 郑波[1] 童朝阳[1] 江松[1] 赵田镜 

机构地区：[1]重庆市第九人民医院放射科,重庆400700

出　　处：《中国CT和MRI杂志》2015年第8期80-83,共4页Chinese Journal of CT and MRI

摘　　要：目的评价多层螺旋CT用于鉴别粘液性与非粘液性结直肠癌的价值。方法收集经病理学确诊为结直肠粘液性癌患者69例和非粘液性癌患者85例的MSCT影像资料,对其MSCT特征进行回顾性分析,并比较两种肿瘤肠壁受累方式、增强形式、继发性肠梗阻、瘤内钙化、肠周脂肪浸润、以及对邻近器官侵犯等特征的差异。结果粘液性癌肠壁增厚(2.52±1.14cm)程度较非粘液性癌(1.91±0.96cm)更重(P=0.003),粘液性癌有84.1%表现为不均匀强化,较非粘液性癌(51.8%)更常见(P=0.001),且粘液性癌的低密度范围更大(P=0.001),偏心程度更高(P=0.027)。与非粘液性癌比较,粘液性癌的实性成分强化程度更低(P=0.001),瘤内钙化更常见(P=0.001)。在两种肿瘤的鉴别诊断中,不均匀强化的敏感度最高(84.1%),特异性中等(58.4%),当4种以上MSCT特征存在显著性差异时,则肿瘤很可能是粘液性癌,其特异性为90.5%。结论MSCT可作为鉴别粘液性与非粘液性结直肠癌的有效检查方法。Objective To evaluate the value of multislice spiral CT（MSCT） in the differentiation between mucinous and non-mucinous colorectal carcinoma. MethodsMSCT imaging data of 69 patients with mucinous colorectal carcinoma and 85 patients with nonmucinous colorectal carcinoma confirmed by pathology were analyzed retrospectively. MSCT findings were compared between the two groups with regard to the bowel involvement patterns, patterns of contrast enhancement, secondary bowel obstruction, intratumoral calcification, pericolic fat infiltration, and tumor extension to adjacent organs. Results Compared with nonmucinous carcinoma, mucinous carcinoma showed more severe bowel-wall thickening（2.52±1.14 cm vs 1.91±0.96cm）（P=0.003）.Heterogeneous enhancement was more common in mucinous than nonmucinous carcinoma（84.1% vs 51.8%）（P=0.001）. Mucinous carcinoma showed more areas with low density（P=0.001） and more eccentric degree（P=0.027）,and its solid portion showed less enhancement than that of nonmucinous carcinoma（P=0.001）, and the presence of intratumoral calcification were more frequent in mucinous carcinoma（P=0.001）. Heterogeneous enhancement showed the highest sensitivity（84.1%） but moderate specificity（58.4%） in diagnosing mucinous carcinoma. Tumors with four or more CT findings with a statistically significant difference were mostly mucinous carcinoma, and the specificity was 90.5%. Conclusion Conclusion MSCT can be used as an effective method for the differential diagnosis between mucinous and nonmucinous colorectal carcinoma.

关 键 词：结直肠肿瘤 体层摄影术 X线计算机 鉴别诊断 

分 类 号：R735.3[医药卫生—肿瘤] R445.2[医药卫生—临床医学]