64层螺旋CT在结直肠癌术前分期中的临床应用

Clinical application of 64-slice spiral CT in preoperative staging of colorectal neoplasms

目的:评价64层螺旋CT检查在结直肠癌术前分期中的应用价值。方法:应用64层螺旋CT对37例临床高度怀疑或内镜活检证实的结直肠癌患者行一次屏气全结肠容积扫描,并利用工作站进行后处理以获取CT仿真肠镜(CTVC)、多平面重建(MPR)、表面阴影成像(SSD)和透明显示(Raysum)图像,并结合原始横断面等图像与手术病理进行分析比较。结果:64层螺旋CTVC能显示结肠癌的大体分型,判断正确率为91.90%;MPR能直观反映癌肿处肠壁及肠周受侵状况,判断正确率达100%;Raysum在显示癌肿的长度上占优势,判断正确率达100%。术前T分期敏感度为100%,阳性诊断准确度为89.2%(33/37)。N分期敏感度为80%(24/30),阳性诊断准确度为70%(21/30)。结论:64层螺旋CT三维重建技术及仿真内镜可以有效地显示肿瘤的形态、大小和部位,并能确定肿瘤的侵犯范围、淋巴结转移和远处转移等,可以更准确地进行术前TNM分期。

Objective： To evaluate the value of 64-slice spiral CT in preoperative staging of colorectal carcinoma. Methods： Thirty-seven patients, who were strongly suspected to have colorectal carcinoma, underwent 64-slice CT before and after intravenous injection of iodinated contrast agent. CT virtual coloscopy（CTVC）, MPR, SSD and Raysum images were obtained by using 4 different softwares in workstation. The results of 64-slice CT were compared with the findings of postoperative pathology. Results： 64-slice spiral CTVC could be helpful in showing the pathologic patterns of carcinoma, its accuracy rate was 91.90%. MPR was helpful for displaying directly the invasion of colonic wall and peficolic organ from colon carcinoma. The accuracy rate was 100%. Raysum was better to display the length of tumor, and its accuracy rate was 100%. MSCT pneumocolon examinations demonstrated 37 colorectal carcinoma. Sensitivity and positive accuracy value for T staging were 100%（37/ 37） and 89.2%（33/37）, respectively; Sensitivity and positive accuracy value for lymph node involvement were 80%（24/30） and 70%（21/30）, respectively. Conclusion： 64-slice spiral CT 3D-reconstructive images and virtual colonoscopy is a better method of depicting colorectal carcinoma, it could be more helpful to precise localizing and qualitative diagnosis. And it allows accurate staging for colorectal carcinoma, especially in detecting the invasion of adjacent tissues and distant metastasis.