螺旋CT检查在食管癌侵犯胸主动脉诊断中的应用

The application of spiral CT in diagnosis of invaded thoracic aorta by esophageal carcinoma

目的:探讨螺旋CT检查在食管癌侵犯胸主动脉诊断中的价值。方法:100例食管癌患者术前进行胸部螺旋CT检查,分别以食管与胸主动脉之间的脂肪间隙是否存在、食管壁的厚度、食管接触胸主动脉的夹角为标准判断胸主动脉是否受侵,并与手术及术后病理学检查结果进行比较。结果:(1)脂肪间隙消失18例,14例(77.78%)外侵,4例(22.22%)无外侵;(2)食管壁厚度<1 cm 12例,3例(25.00%)外侵,9例(75.00%)无外侵; 食管壁厚度>2 cm 23例,19例(82.61%)外侵,4例(17.39%)无外侵;食管壁厚度1～2 cm 6s例,8例(12.31%) 外侵,57例(87.69%)无外侵;准确度为80.00%(28/35);(3)食管肿瘤与胸主动脉之间的夹角<45°43例,4例(9.30%)外侵,39例(90.70%)无外侵;两者之间夹角>90°17例,12例(70.59%)外侵,5例(29.41%)无外侵;两者之间夹角45°-90°40例,17例(42.50%)外侵,23例(57.50%)无外侵;准确度达85.00%(51/60)。结论:术前螺旋CT检查对判断食管癌有无胸主动脉受侵有较大的应用价值。

Objective： To explore the value of preoperative spiral CT examination in the diagnosis of invaded thoracic aorta by esophageal carcinoma. Methods： All the 100 patients with diagnosed esophageal carcinoma by pathological examination took spiral CT and were analyzed preoperatively. Exist of fat space between esophagus and thoracic aorta, the thickness of esophagus wall and the angle of esophagus touched thoracic aorta were the criteria of diagnosis. All the results of spiral CT examination were compared with the results of their postoperative histopathological status. Results. （1）Among 18 cases with fat space between esophagus and thoracic aorta disappeared, 14 cases thoracic aorta invaded（77.78%）, 4 cases thoracic aorta noninvaded（12.22%）; （2） Among 12 cases with the thickness of esophagus wall less than 1cm, 3 cases thoracic aorta invaded（25.00%）, 9 cases thoracic aorta noninvaded（75.00%）. Among 23 cases with the thickness more than 2cm, 19 cases thoracic aorta invaded（82.61%）, 4 cases thoracic aorta noninvaded（17.39%）. Among 65 cases with the thickness between 1cm and 2cm, 8 cases thoracic aorta invaded（12.31%）, 57 cases thoracic aorta noninvaded（87.69%）, sensitivity, specificity, accuracy were 82.35% （14/17）, 95.18%（79/83）, 93.00%（93/100） respectively; （3） Among 43 cases with the angle of esophagus touched thoracic aorta less than 45 degree, 4 cases thoracic aorta invaded（9.30%）, 39 cases thoracic aorta noninvaded（90.70%）. Among 17 cases with the angle more than 90 degree, 12 cases thoracic aorta invaded（70.59%）, 5 cases thoracic aorta noninvaded（29.41%）. Among 40 cases with the angle between 45 and 90 degree, 17 cases thoracic aorta invaded（42.50%）, 23 cases thoracic aorta noninvaded（57.50%）. Accuracy was 85.00%. Conclusion： Preoperative spiral CT examination has a greater value in the diagnosis of the invaded thoracic aota by esophageal carcinoma.