结肠癌术前多层面CT一站式检查的临床价值

Value of multi-slice computed tomography in preoperative "one-station-style" examination for colon cancer

目的:评估结肠充气多层CT(MSCT)多期增强扫描对结肠癌患者术前检查的价值.方法:63例结肠癌患者术前1 wk内行全腹MSCT平扫与多期增强MSCT扫描.采用Toshiba Aquilion16扫描仪,增强扫描是在对比剂开始注射后22 s(Ⅰ期)、37-40 s(Ⅱ期)、60 s(Ⅲ期)采集数据.在工作站对采集数据行CT仿真内镜(CTC)、X线模拟投影(XRP)、多平面重组(MPR)、表面遮盖显示(SSD)、CT血管造影(CTA)等后处理观察,并与手术病理对照.结果:CT显示64个癌灶,升结肠18个,结肠肝曲2个,横结肠4个,结肠脾曲2个,降结肠6个,乙状结肠20个(包括乙状结肠与直肠交界区5个),直肠12个;16例发现肠外病变;与手术所见同.在不同扫描期相,原发灶为均匀或不均匀强化.增强扫描肿物峰值强化Ⅱ期30个,Ⅱ期-Ⅲ期17个,Ⅲ期13个,Ⅰ-Ⅲ期4个.58个原发灶(90.6%)可见相应供血动脉增粗,分支增多.CT判断是否累及肠周脂肪敏感性100%,特异性64.2%,准确性92.1%.CT对腹部淋巴结转移瘤诊断总的敏感性78.5%,特异性86.7%,准确性86.1%.结论:MSCT多期增强扫描一次检查为结肠癌术前了解肿瘤位置、数量、范围、血供及其他组织器官病变情况提供了其他影像技术难于同时提供的信息.

AIM： To assess the value of three-phase contrasted multi-slice computed tomography （MSCT） pneumocolon in preoperative examina- tion of colon cancer. METHODS： Sixty-three patients with colonic cancer underwent plain MSCT pneumocolon and multiphase contrasted MSCT within I week before operation. Contrasted MSCT scans were performed using 16-slices CT system （Toshiba aquilion16） 22 s （phase Ⅰ ）, 37-40 s （phase Ⅱ ） and 60 s （phase Ⅲ） after intravenous administration of contrast medium. Images were then obtained by CT colonography （CTC）, X-ray projection （XRP）, multi-planar reformation （MPR）, surface shadow display （SSD）, CT angiography （CTA） in post-procession workstation. The results were comparatively analyzed with the surgical pathology. RESULTS： Sixty-four cancer lesions were detected on CT images and in surgery. They located in ascending colon （18 lesions）, hepatic flexure of colon （2 lesions）, transverse colon （4 lesions）, splenic flexure of colon （2 lesions）, descending colon （6 lesions）, sigrnoid （20 lesions, of which 5 lesions in the injunction of sigrnoid and rectum）, and rectum （12 lesions）. Extracolonic diseases were found in 16 patients by MSCT or surgery. On multi-phase contrasted CT images, colon caner lesions demonstrated homogeneous or inhomogenous enhancement, and the absolutely increased peaks in CT density were at phase Ⅱ （30 lesions）, phase Ⅱ-Ⅲ （17 lesions）, phase Ⅲ（13 lesions） and phase Ⅰ -Ⅲ （4 lesions）. CTA detected blood-supplying artery of 58 cancer lesions （90.6%）. The sensitivity, specificity and positive accuracy were 100%, 64.2%, and 92.1% respectively, for pericolonic fat involvement, and 78.5%, 86.7%, and 86.1% respectively, for abdominal metastasis-positive lymph-nodes. CONCLUSION： MSCT pneumocolon and preoperative three-phase contrasted CT can provide information about tumor location, number, stage, blood-supplying artery and extracolonic diseases.