进展期结直肠癌MSCT评估周围组织结构是否侵犯的意义

Significance of MSCT Signs in Advanced Colorectal Cancer in Assessing the Presence or Absence of Invasion of Surrounding Tissue Structures

目的探讨结直肠癌的CT影像学特征及其评估周围组织结构是否侵犯中的意义。方法采用回顾性分析方法,搜集经病理证实结直肠癌患者的临床资料,共33例,男14例,女19例;年龄45~86岁,中位年龄65岁。33例患者均进行CT增强扫描,其中18例术前CT检查显示可疑周围结构或脏器受侵犯、术中证实未受侵的患者设为SN组,15例手术证实受侵犯设为SI组。观察指标:结直肠癌与周围组织结构接触面形态分型;两组患者结直肠癌厚度、结直肠癌与周围组织结构接触面长度及清晰度。结果SN与SI组患者的结直肠癌厚度、接触面长度比较,差异均无统计学意义(P>0.05)。两组患者的结直肠癌肿与周围组织结构接触面清晰度及接触面形态分型比较,差异有统计学意义(P<0.05);其中接触面清晰度判断有无侵犯的敏感度为86.66%,特异度为83.33%,接触面Ⅳ型判断有无侵犯敏感度为60%,特异度为100%。结论结直肠癌侵犯周围组织结构时多表现为结节外突,接触面模糊,周围组织结构接触面呈凹陷或嵌插改变,或者无直接接触但间隙模糊,呈污垢样或条索状改变。

Objective To explore the CT imaging characteristics of colorectal cancer and its significance in evaluating whether the surrounding tissue structure is invaded.Methods Retrospective analysis method was used.The clinical data of patients with colorectal cancer confirmed by pathology were collected.There were 33 cases,including 14 males and 19 females;aged from 45 to 86 years,with a median age of 65 years.All 33 patients underwent enhanced CT scans.Among them,18 preoperative CT examinations showed suspicious violations of surrounding structures or organs.Patients with structure negative(SN)confirmed during the operation were set as the SN group,and 15 cases were confirmed to be affected by surgery.Structure invasion(SI)is set as the SI group.Observation indicators:(1)Morphological classification of the contact surface between colorectal cancer and surrounding tissues.(2)Comparison of CT examinations between the two groups:the thickness of colorectal cancer,the length and clarity of the contact surface between colorectal cancer and surrounding tissues.Results There was no significant difference in colorectal cancer thickness and contact surface length between SN and SI groups(P>0.05).There was a statistically significant difference in the definition of the contact surface between the colorectal cancer and the surrounding tissue structure and the morphological classification of the contact surface between the two groups of patients(P<0.05);among them,the sensitivity of the clarity of the contact surface to judge whether there was invasion was 86.66%,The specificity was 83.33%,the sensitivity of the contact surface typeⅣto judge whether there is violation was 60%,and the specificity was 100%.Conclusion When colorectal cancer invades the surrounding tissue structure,it usually manifests as nodules protruding,the contact surface is blurred,the contact surface of the surrounding tissue structure is recessed or inserted,or there is no direct contact but the gap is fuzzy,showing dirt-like or strip-like changes.