螺旋CT进行直肠癌术前肿瘤和淋巴结分期及术后病理分期的准确性和实用价值研究  

Accuracy and practical value of spiral CT for preoperative tumor and lymph node staging and postoperative pathological staging

作　　者：王俊峰[1] 姜业红[1] 高朝前 陈士兵[1] 翟采文 李厚成[1] 

机构地区：[1]湖北省枣阳市第一人民医院放射科,湖北枣阳441200

出　　处：《海南医学院学报》2016年第6期620-624,共5页Journal of Hainan Medical University

基　　金：襄阳市科技研发(EK2012D140143001063)~~

摘　　要：目的:利用螺旋CT(SCT)进行直肠癌术前肿瘤(T)和淋巴结(N)分期,并与术后病理分期对比,分析该检查方法的准确度。同时利用SCT三维成像技术(MRP)测量中、低位直肠癌距肛门缘距离,与结肠镜和直肠指诊的测量结果对照,评价该技术的准确性和实用价值。方法:SCT术前检查的研究纳入46例病人,其中33例为中低位直肠癌。均由电子结肠镜和活检证实诊断。检查前清洁肠道,以5mm层厚从骶髂关节上方连续扫描到坐骨结节水平,扫描数据在工作站进行重建和分析。将SCT诊断结果和术后病检结果对照,评价术前分期的准确度。利用SCT三维重建、直肠指诊、结肠镜三种方法测量33例中低位直肠癌病人肿瘤下缘到肛门缘的距离,并和术后测量的实际距离进行对比,分析三种测量方法的准确度。再对15例肿瘤远端距离≤6 cm的患者进行亚组分析。比较直肠指诊和SCT对低位及超低位直肠癌远端距离测量的准确性。结果:所有病人均顺利完成检查,SCT判断T分期的准确度为73.9%,且对进展期直肠癌T分期准确性更高。N分期的准确度的为67.4%。判断淋巴结转移的敏感度为91.3%,特异度为69.6%。经Kappa检验证明SCT对T和N分期的结果与术后病理分期的一致性中等,Kappa值分别为0.479和0.569。对33例中低位直肠癌术前测量肿瘤下缘到肛门缘距离的研究发现,SCT、直肠指诊和肠镜检查测得的肿瘤下缘距离与实际距离平均差值分别为0.78 cm、1.68 cm和1.81 cm。允许测量结果和实际距离的误差为1 cm时,三种检查方法的准确度分别为84.8%、48.5%和36.4%,差异有显著意义(P<0.005)。而对15例低位直肠癌(实际距离≤6 cm),SCT和肛门指诊测得的距离与实际距离平均差值分别0.63 cm和0.68 cm,在允许误差为0.5 cm时,两种检查方法的准确度无显著差异(P=0.245)。结论:SCT对进展期直肠癌术前分期有较高的可靠性,但对T1、T2期仍有一定限�Objective： To evaluate the accuracy of spiral CT （SCT） by establishing multiplanar reconstruction images for preoperative staging of rectal tumor （T） and lymph node （N） and comparing the postoperative pathological stages. Meanwhile, SCT 3D magnetic resonance portography was used to determine the distance of rectal cancer from anal edge and the results were compared with those with usage of colonoscope and rectal palpation to assess the accuracy and practical value of SCT. Methods： A total of 46 consecutive patients accepted SCT staging, among which 33 patients were diagnosed with mid or low rectal tumors by electronic colonoscope and biopsy. The intestine tracts of all the patients were cleaned the day before the examination. With the patients in the prone position, contiguous slices were obtained at 5 mm beginning at the sacroiliac joints and ending at the ischial tuberosity. Data were analyzed and multiple planner was reconstructed on the workstation. The SCT staging was compared with pathological staging examination for the assessment of accuracy of preoperative staging. For the patients with mid or low rectal tumors, lesion distance from the anal verge was measured by SCT （designated as T distance）, rectal palpation （P distance） and colonscope （C distance）, and compared with the distance measured on the postoperative excised specimen （real distance） to evaluate the accuracy of these three measurements. A total of 15 patients with the real distance ≤ 6 cm were brought into a subgroup to compare the accuracy of rectal palpation and SCT in low and ultra-low rectal tumors. Results： All the patients successfully completed SCT scanning. The accuracy of T stage was 73.9%, and the results for the advanced rectal tumor were more accurate. In the detection of lymph node, the accuracy of N stage was 67.4% （sensi- tivity 91.3%, specificity 69.6%）. A moderate concordance between the SCT staging and the postoperative histopathological staging was determined by the Kappa test, with Ka

关 键 词：直肠肿瘤 X线计算机 体层摄影术 肿瘤分期 

分 类 号：R735.37[医药卫生—肿瘤]