多层螺旋CT在胃肠道肿瘤诊断中的价值

Value of multi.slice spiral computed tomography in the diagnosis of gastrointestinal cancer

目的探讨多层螺旋CT（MSCT）检查在胃肠道肿瘤术前定位与分期诊断中的临床价值。方法（1）对胃镜活组织检查确诊为胃癌的332例患者进行术前MSCT检查，比较CT分期结果与术后病理检查结果。（2）对73例小肠肿瘤患者进行术前CT检查，比较小肠淋巴瘤和小肠癌在CT成像上的区别。（3）对228例经纤维结肠镜活组织检查确诊为结直肠癌患者进行术前MSCT检查，采用X^2检验分析结直肠癌的CT征象特点。结果（1）MSCT能提供定位或重建胃周血管等更多信息，对胃壁浸润深度、淋巴结转移、远处转移的总体诊断准确率分别为78．2％（244／312）、67．3％（210／312）和93．8％（30／32）。（2）MSCT检查小肠癌主要表现为包块和肠壁浸润性增厚，且肠壁增厚一般不出现分层，肠梗阻多见，但肠系膜淋巴结和后腹膜淋巴结肿大检出率低。小肠淋巴瘤的CT检查表现与小肠癌相反。（3）表面毛糙征与不均匀强化等CT征象对诊断结直肠癌有重要意义，增强后CT值测定有助于鉴别结肠炎性病变。结论MSCT可在胃肠道肿瘤术前定位与分期诊断中提供准确的影像学信息，结合内镜检查更能提高诊断准确率。

Objective To evaluate multi-slice spiral computed tomography （MSCT） in the diagnosis and preoperative staging of gastrointestinal cancer. Methods （1） Three hundred and thirty-two gastric cancer patients underwent preoperative MSCT examination. The staging of gastric cancer by MSCT was compared with histological examination. （2） Seventy-three small intestinal cancer patients underwent preoperative MSCT, and 70 healthy adults were selected as normal control. The MSCT images of small intestinal lymphoma and small intestinal cancer were compared with those of normal small intestine. （3） Two hundred and twenty-eight colorectal cancer patients underwent preoperative MSCT, and the features of the MSCT images of colorectal cancer were analyzed by chi-square test. Results （1） The overall accuracy of MSCT in the assessment of gastric wall invasion, lymph node metastasis and distal metastasis were 78.2% （244/312）, 67.3% （210/312） and 93.8% （30/32）, respectively. More information such as the location of lesions and the vessels around the stomach could be provided by MSCT image. （2） Abdominal masses, diffuse thickening of intestinal wall and intestinal obstruction were the main features of small intestinal cancer, while mesenteric and retroperitoneal lymph nodes metastases were rarely detected. The presentation of small intestinal lymphoma detected by MSCT were completely the opposite. （3） Signs such as ＂coarse surface＂ and ＂heterogeneous enhancement＂ were important to the diagnosis of colorectal cancer. The measurement of the MSCT value is helpful in the differential diagnosis of colorectal cancer and colonic inflammation. Conclusions MSCT can provide correct imaging information on the diagnosis and preoperative staging of gastrointestinal cancer. The combination of MSCT and endoscopy can improve the accuracy of diagnosis.