低剂量CT扫描在结直肠癌原发瘤T分期的应用价值  

The Application Values of Low Dose CT Scan in T Staging of Colorectal Cancer’s Primary Tumor

作　　者：欧阳晓明 龙晓东 谢勇刚 OUYANG Xiaoming;LONG Xiaodong;XIE Yonggang(Department of Radiology,Dongguan Hengli People Hospital,Dongguan,Guangdong Province 523460,P.R.China)

机构地区：[1]东莞市横沥医院放射科,523460

出　　处：《临床放射学杂志》2021年第8期1550-1555,共6页Journal of Clinical Radiology

基　　金：东莞市社会科技发展(一般)项目(2019)(编号:201950715038902)。

摘　　要：目的评估腹部低剂量CT扫描的图像质量及其在结直肠癌原发瘤分期的价值。方法对39例结直肠癌患者行腹部低剂量(低kV)CT扫描(迭代重组算法),并与39例常规剂量CT扫描(反投影算法)的结直肠癌患者作比较,两组患者均经组织病理学证实及手术T分期。计算患者的体质指数(BMI)和辐射剂量参数。测量和计算图像质量的量化指标对图像质量进行评估。然后进行结直肠癌原发瘤的T分期(≤T2、T3、≥T4a),为了明确浆膜层是否侵犯,对≤T3/≥T4a进行区分。CT观察结果与手术分期进行对照,比较低剂量组和常规剂量组的辐射剂量、图像质量和原发瘤T分期的准确性。结果低剂量扫描组有效辐射剂量(ED)为(7.06±1.44)mSv,显著低于常规剂量组(12.96±2.80)mSv,减低幅度达45.52%(P<0.05)。低剂量组对比噪声比(CNR)为3.51±1.55,显著高于常规剂量组3.01±0.81(P<0.05),两组患者图像结构锐利程度半定量分析中数据无统计学差异。低剂量组手术分期:≤T25例、T314例和≥T4a 20例,CT分期:≤T2正确1例、T3正确11例、≥T4a正确20例,准确率达82.05%;常规剂量组手术分期:≤T25例、T313例和≥T4a 21例,CT分期:≤T2正确2例、T3正确8例、≥T4a正确20例,准确率为76.23%。两组无统计学差异。在区分≤T3/≥T4a中低剂量组手术结果:≤T319例,≥T4a 20例;CT判断:≤T317例、≥T4a 22例。常规剂量组手术:≤T318例,≥T4a 21例;CT判断:≤T315例、≥T4a 24例。两组判断准确率无统计学差异。结论低剂量+迭代重组算法结直肠癌CT扫描辐射剂量明显降低,图像质量高,对原发瘤的T分期准确性较高,特别是判断肿瘤是否突破浆膜层更具优势,说明本研究方法和观察结果对临床具有重要的应用价值。Objective To evaluate imaging quality of low dose abdomen CT and values in T staging of colorectal cancer’s primary tumor.Methods Low dose abdomen CT(Iterative Algorithm Reconstruction)were done in 39 patients with colorectal cancers,compared with conventional dose CT(Reconstruction of Counter-Injection)in 39 cases with colorectal cancers which diagnosing were proved by histopathology and operative T staging.The body mass index(BMI),radiation dose parametersand quantitative indexs of imaging qualitywere measured and calculatedin all the patients.T staging(≤T2、T3、≥T4 a)of primary tumor in colorectal cancer were performed.For clarified if tumor infiltrated serous membrane,≤T3/≥T4 a were differentiated in CT imaging.By means of collating operative T staging with observed results of CT,radiation dose,imaging quality and the CT accuracy of T staging in primary tumor were compared between low dose group and conventional dose group.Results ED in low dose group was(7.06±1.44)mSv and lower than conventional dose group which ED was(12.96±2.80)mSv.ED in low dose group decreases 45.02%of conventional dose group.The difference had statistical significance(P<0.05).CNR in low dose group was 3.51±1.55 and higher than conventional dose group 3.01±0.81(P<0.05).In the semi-quantitative analysis in marginal sharpness of tumor,the data hadn’t statistical difference between 2 groups.The operative staging of patients in low dose group was followed as:5 cases in≤T2,14 cases T3 and 20 cases≥T4 a,and correct CT staging was:1 cases in≤T2,11 cases T3 and 20 cases≥T4 a which accuracy were 82.05%.The operative staging of conventional dose group was followed as:5 cases in≤T2,13 cases T3 and 21 cases≥T4 a,and correct CT staging was:2 cases in≤T2,8 cases T3 and 20 cases≥T4 a which accuracy were 76.23%.The accuracy between 2 groups hadn’t statistical difference.Of differentiating≤T3/≥T4 a,operation approved 19 cases≤T3,20≥T4 a,there were 18 cases≤T3,21≥T4 a by CT estimating in low dose group.Opera

关 键 词：结直肠癌 多层螺旋CT 肿瘤T分期 低剂量扫描 迭代算法重组 

分 类 号：R735.34[医药卫生—肿瘤] R730.44[医药卫生—临床医学]