第三代双源CT低剂量仿真结肠镜诊断结直肠癌可行性的临床研究  

The feasibility of the 3rd generation low-dose dual-source CT virtual colonscopy in the diagnosis of colorectal cancer

作　　者：黄天骄 史学森[2] 孙凯[3] 韩洋[3] 夏丽萍 HUANG Tianjiao;SHI Xuesen;SUN Kai;HAN Yang;XIA Liping(Second Affiliated Hospital of Qiqihar Medical College,Qiqihar 161000,China;Baotou Cancer Hospital;Department of Medical Imaging,Baotou Central Hospital;Department of Internal Medicine,Hegang Nanshan Hospital)

机构地区：[1]齐齐哈尔医学院附属第二医院,齐齐哈尔161000 [2]包头市肿瘤医院 [3]包头市中心医院影像科 [4]鹤岗市南山区人民医院内科

出　　处：《国际医学放射学杂志》2018年第2期142-145,207,共5页International Journal of Medical Radiology

摘　　要：目的探讨第三代双源CT Turbo Flash模式低辐射剂量仿真结肠镜检查对结直肠癌早期筛查的准确性及诊断结直肠癌的可行性。方法选取包头市肿瘤医院2016年1月—2017年3月疑诊结直肠癌的病人230例,其中筛选出同时进行CT仿真结肠镜(CTVC)和结肠镜检查及病理活检的病人56例,其中男29例,女27例,年龄38~83岁,平均(64±11)岁。以病理结果为金标准,计算CTVC诊断结直肠癌的敏感度、特异度、阳性预测值、阴性预测值。由2名副主任医师评价分析CTVC的影像质量,客观评价指标及辐射剂量的比较采用独立样本t检验,主观评分比较采用Wilcoxon秩和检验。绘制CTVC和粪便隐血试验(FOBT)检查联合诊断结肠占位性病变的受试者操作特征(ROC)曲线,并计算ROC曲线下面积(AUC)。结果 CTVC的影像客观质量评价与常规扫描相比差异无统计学意义(P>0.05),影像主观质量评价均≥3分,影像清晰可达到诊断要求。CT Turbo Flash模式下的CTVC检查的平均辐射剂量为(2.07±0.30)m Sv,明显低于常规扫描的辐射剂量(4.04±0.66)m Sv(t=-14.612,P<0.001)。CTVC诊断结直肠癌的敏感度为97.30%,特异度为89.47%,阳性预测值为94.74%,阴性预测值为94.44%。与单独采用CTVC及FOBT诊断结直肠癌相比,CTVC与FOBT联合诊断的效能更高(AUC=0.964,95%CI:0.900~1.000)。结论 CTVC检查结直肠癌筛查影像清晰、辐射剂量低、有较高的敏感性和特异性,且联合FOBT可提高结直肠癌高危人群的筛检准确性。Objective To investigate the accuracy of colonoscopy in screening of the early-stage colorectal cancer and the feasibility of the 3rd generation dual source CT virtual colonoscopy with Turbo Flash mode in the diagnosis of colorectal cancer.Method A total of 230 patients with suspected colorectal cancer were enrolled from January 2016 to March 2017 in Baotou Tumour Hospital.Among them,29 male cases and 27 female cases(age range from 38 to 83 years,average age 64±11 years)who had undergone CT virtual colonoscopy(CVTC)examination and colonoscopy and pathological biopsy were included in final analysis.Pathological result was used as gold standard.The sensitivity,specificity,positive predictive value,and negative predictive value of CTVC in diagnosis of colorectal cancer were calculated.The CTVC image quality was evaluated by two associate chief physicians.The CTVC image quality was evaluated by comparing objective evaluation indexes and radiation dose using independent sample t test,and subjective scores using Wilcoxon test.The area under receiver operating characteristic curve(AUC)of combination of CTVC examination and faecal occult blood test(FOBT)for colorectal cancer was calculated.Results The objective image quality was not statistically significant between low-dose and conventional CTVC(P>0.05).The image subjective quality scores were≥3,the images were clear enough to meet the diagnostic requirement.The average radiation dose of CTVC in CT Turbo Flash mode was 2.07±0.30 mSv,which was significantly lower than that of routine scanning of 4.04±0.66 mSv(t=-14.612,P<0.001).The sensitivity of CTVC in the diagnosis of colorectal cancer was 97.30%,specificity was 89.47%,positive predictive value was 94.74%,and negative predictive value was 94.44%.Compared with using CTVC and FOBT in the diagnosis of colorectal cancer alone,the combination of CTVC and FOBT had a higher effectiveness(AUC=0.964,95%CI:0.900-1.000).Conclusions CTVC colorectal cancer screening has the characteristics of low radiation dose and clear imag

关 键 词：结直肠癌 双源CT仿真结肠镜 电子结肠镜 低辐射剂量 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]