64排螺旋CT中“管壁僵硬”和“外膜毛糙”征象对结直肠癌术前分期的价值

Value of "rigid wall" and "outer coarse" signs in 64-slice CT for pre-operation staging of colorectal carcinoma

目的探讨CT检查中"管壁僵硬"和"外膜毛糙"征象对结直肠癌术前分期的价值。方法收集结直肠癌患者123例的CT检查资料,对"管壁僵硬"和"外膜毛糙"进行评估,并根据术后病理肿瘤浸润的深度进行分组,分别对浸润深度相邻的两组病例进行征象比较及分析,对两种征象与肿瘤浸润深度进行相关分析及比较。结果本组7例Tis,6例T1,14例T2a,16例T2b,75例T3(侵达浆膜:22例;侵达浆膜外:53例),5例T4;根据病理浸润深度分为Ⅰ组:Tis+T1;Ⅱ组:T2a:Ⅲ组:T2b;Ⅳ组:T3a;Ⅴ组:T3b+T4。Ⅰ组与Ⅱ组"管壁僵硬"发生率、Ⅱ组与Ⅲ组"外膜毛糙"发生率差异有统计学意义(P=0.013,P=0.004)。"管壁僵硬"、"外膜毛糙"均与肿瘤浸润深度相关(r=0.673,r=0.528,P均<0.001);而"管壁僵硬"与"外膜毛糙"存在正相关(r=0.725,P<0.001)。以"管壁僵硬"预测T1期病变敏感度92.30%、特异度89.09%、准确率89.43%;以"外膜毛糙"预测T3及T3期以上病变敏感度79.31%、特异度69.44%、准确率76.42%。结论"管壁僵硬"对于鉴别T1与T1期以上病变具有较高的价值;"外膜毛糙"更有助于鉴别T2a与T2a期以上病变,但无法区分T2b与T3期病变。"管壁僵硬"和"外膜毛糙"与肿瘤浸润深度呈正相关,两种征象结合有望提高结直肠癌肿瘤分期的准确率。

Objective To assess the value of ＂rigid wall＂ and ＂outer coarse＂ signs in 64-slice CT for pre-operation stages of eolorectal carcinoma. Methods One hundred and twenty-three coloreetal carcinoma patients underwent 64-slice CT; then ＂rigid wall＂ and ＂out coarse＂ signs were evaluated respectively. The tumors were grouped according to the postopera- tive pathologic infiltrative depth. Two signs of the neighboring infiltrative depth groups were compared and analyzed, so as the relativity between two signs and tumor infiltrative depth. Results Among all 123 patients, 7 were Tis, 6 were T1, 14 were T2a, 16 were T2b, 75 were T3 （including 22 infiltrate to chorion and 53 infiltrate through ehorion） and 5 were T4. According to the pathologic infiltrative depth, the patients were grouped into Group ~ ： Tis＋T1 ; Group 1I ： T2a; Group 11I： T2b; Group IV： Taa; Group V： T3b-kT4. Significant difference of the incidence of ＂rigid wall＂ was found between Group Ⅰ and Ⅱ （P=0. Ola）, while of ＂outer coarse＂ between Group Ⅱ and Ⅲ （P=0. 004）. Coefficient correlation of ＂rigid wall＂, ＂outer coarse＂ and the infiltrative depth of the tumor were detected （r= 0. 673, r= 0. 528, respectively, both P〈0. 001）, also between the two signs （r=0. 725, P〈0. 001）. To predict the tumor of and above T1 with ＂rigid wall＂ and tumor of and above Tda with ＂outer coarse＂, the sensitivity, specificity and accuracy was 92. 30% and 79. 31 ~/00, 89.09% and 69.44%, 89.43% and 76.42%, respectively. Conclusion The sign of ＂rigid wall＂ is valuable to distinguish the pathological changes in the tumor of and above T1, while ＂outer coarse＂ is better to distinguish the pathological changes of and above T2a, but not good at distinguishing tumors of T2b and T3 or above. ＂Rigid wall＂ and ＂outer coarse＂ are both in positive correlation with the infiltrative depth of the tumor, and each has different values. Combination of the two signs may be helpful to raise the accuracy for pre-operation staging of colorectal carcinoma.