多层螺旋增强扫描在结直肠癌术前分期中的价值  

Value of enhanced multi-detector computed tomography scan in preoperative staging of colorectal cancer

作　　者：陈天佑[1] 吉学生[1] 陆娜[1] 强金伟[1] 廖治河[1] 

机构地区：[1]复旦大学附属金山医院放射科,上海201508

出　　处：《肿瘤影像学》2015年第4期274-278,共5页Oncoradiology

基　　金：上海市科学技术委员会引导类项目(No:134119b1600);上海市卫生与计划生育委员会青年科研项目(No:2011-187);上海市金山区卫生系统优秀青年人才培养计划(No:JWKJ-RCYQ-201202)

摘　　要：目的:探讨多层螺旋CT(multi-detector computed tomography,MDCT)增强扫描在结直肠癌术前分期中的临床应用价值。方法:回顾性分析本院30例经手术病理证实结直肠癌患者的CT图像,其中男性14例、女性16例。观察全腹部CT平扫+增强图像,并进行多平面重建(multi-planner reconstruction,MPR),确定结直肠癌的CT分期,并与术后病理对照。结果:MDCT增强扫描对30例结直肠癌患者T分期的总体诊断准确率为73%,其中T1+T2、T3、T4分期的准确率分别为60%、78%、100%。CT增强扫描评价结直肠癌浆膜面受侵的灵敏度、特异度、阳性预测值、阴性预测值分别为80%、60%、80%、60%;CT增强扫描对结直肠癌N分期的诊断准确率为63%,其中N0、N1、N2分期的准确率分别为85%、14%、33%。CT增强扫描评价结直肠癌淋巴结转移的灵敏度、特异度分别为40%、85%,阳性预测值和阴性预测值分别为57%、73%。结论:MDCT对评价结直肠癌T分期、浆膜面受侵、N分期、淋巴结转移均有一定的价值,诊断结直肠癌浆膜面受侵的准确率较高,对术前分期有一定的指导意义。Objective： To investigate the clinical value of enhanced 128-detector CT scan in the preoperative staging of colorectal cancer. Methods： CT data of 30 patients with pathologically proved colorectal cancer were retrospectively reviewed（14 male and 16 female）. Enhanced CT with multi-planner reconstruction was done to get CT staging. CT staging and pathological staging were compared. Results： In the 30 patients, 22（73%） tumors were correctly T-staged by CT. In T staging, the accuracy was 60% for T1＋T2, 78% for T3, and 100% for T4. The sensitivity, specificity, positive predictive value and negative predictive value of diagnosing the invasion of plasma membrane were 80%, 60%, 80% and 60%, respectively. Nineteen（63%） tumors were correctly N-staged by CT. In N staging, the accuracy was 85% for N0, 14% for N1, and 33% for N2, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of diagnosing the lymph node metastasis were 40%, 85%, 57%, 73%, respectively. Conclusion： Enhanced CT has some value in diagnosing T-staging, invasion of plasma membrane, N-staging and lymph node metastasis. The diagnostic accuracy of invasion of plasma membrane by enhanced 128-detector CT scan is comparatively high.

关 键 词：结直肠癌 计算机断层扫描 分期 

分 类 号：R445.3[医药卫生—影像医学与核医学]