多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值

Diagnostic value of double-phase enhancement and virtual endoscopy with multi-slice spiral CT on clinical staging of preoperative bladder cancer

目的 探讨多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值.方法 经纤维膀胱镜或手术病理证实为膀胱癌患者75例.对患者术前螺旋CT双期增强扫描图像和仿真内镜图像进行分析,比较多层螺旋CT分期与病理分期的准确率.结果 75例患者共发现病灶94个.螺旋CT分期：T1 26例、T2a 27例、T2b 13例、T3 12例、T4 16例;病理分期：pT1 28例、pT2a 24例、pT2b 14例、pT3 12例、pT4 16例.螺旋CT双期增强扫描诊断膀胱癌准确率为89.4%（84/94）;腔内息肉样病变,仿真内镜诊断敏感性96.6%（84/87）;膀胱壁无蒂隆起性病变诊断敏感性为90.9%（10/11）.螺旋CT双期增强扫描结合仿真内镜诊断膀胱癌分期准确率为94.5%（91/94）,当肿瘤局限于膀胱壁内（≤T2b）时,诊断准确率为91.2%（51/56）;肿瘤侵犯膀胱壁外结构时（≥T3）,诊断准确率达100.0%（28/28）.结论 多层螺旋CT双期增强扫描结合仿真内镜成像对膀胱癌术前临床分期具有重要价值.

Objective To determine the diagnostic value of double-phase enhancement and virtual endoscopy with multi-slice spiral CT （MSCT） on clinical staging of preoperative bladder cancer.Methods Seventy-five patients with bladder cancer diagnosed by fibercystoscope or operation. All of them were examined by double-phase enhancement and virtual endoscopy with MSCT. The images were analyzed and clinical staging were obtained. The findings of MSCT （71 cases）were compared with the post-operative histopathological results. Results There were 94 lesions to be found. The staging of MSCT： T1 26 cases,T2, 27 cases, T2b 13 cases, T3 12 cases, T4 16 cases. Histopathological results： pT1 28 cases, pT2a 24 cases, pT2b 14 cases, pT3 12 cases, pT4 16 cases. The sensitivity of preoperative staging on bladder cancer was 89.4 % （84/94） by double-phase enhancement of MSCT;the sensitivity of virtual endoscopy was 96.6% （84/87）for polyploidy tumors and 90. 9 % （10/11） for sessile lesions. When double-phase enhancement and virtual images were evaluated together, the sensitivity rate increased to 94.5%. When the tumors were confined within the bladder wall （≤T2b）, the diagnostic accuracy of double-phase enhancement and virtual images was 91.2% （51/56）. When the tumors had invaded the tissues and organs beyond the bladder wall （≥T3）, the accuracy was 100% （28/28）. Conclusion Double-phase enhancement and virtual endoscopy of MSCT is of great value in clinical staging of bladder cancer.