64层CTA断层图像虚拟技术对结直肠肿瘤诊治的应用评价

Clinical application of 64-slice computed tomographic angiography-based virtual colonoscopy in the diagnosis of colonic tumors

目的探讨64层CTA断层图像虚拟技术在结肠肿瘤诊断及指导治疗中的应用价值。方法应用Philips/Brilliance 64层CT对10例术后病理标本证实的结肠癌(8例)和结肠息肉(2例)进行容积扫描。Mimics软件用MC(Marching Cubes)算法对肠管进行面及用虚拟内镜法重建三维图像及基于CTA二维图像对大肠及周围结构等各种组织进行三维重建。分析病变部位、大小及形态,将影像结果与病理对照。结果 10例三维成像效果良好,图像诊断与病理符合率100%。虚拟内镜与CT仿真内镜显示基本一致。虚拟结肠镜结合多结构数字模型重建,可以提供更多信息,有助于病变的准确定位,能准确反映其复杂的解剖结构及空间毗邻关系。结论虚拟结肠镜结合多结构数字模型重建,不仅无创、有效,更能准确反映病变定位及其复杂的解剖结构及空间毗邻关系,清晰显示肠壁及肠外的转移情况,对结直肠癌的临床分期和手术方案的选择具有重要意义。

Objective To investigate the clinical value of 64-slice computed tomographic angiography（CTA）-based virtual colonoscopy in the diagnosis of colonic tumors.Methods Philips/Brilliance 64 CT volumetric scanning was performed in 8 patients with colonic cancer and 2 with colonic polypi identified by postoperative pathological examination.Mimics software was used for surface rendering of the intestine with the Marching Cubes algorithm for 3-dimensional（3D） virtual endoscope（VE） reconstruction and CTA-based 3D reconstruction of the large intestine and the surrounding structures.The location,volume and appearance of the lesions displayed by the virtual techniques were compared with the pathological results.Results The 3D reconstruction was successfully completed in all the 10 cases,and the imaging diagnoses showed a total match with the pathological diagnoses.No significant differences were found between virtual endoscopy and CT virtual endoscopy.Virtual colonoscopy combined with digital model reconstruction provided valuable information for accurate identification of the position of the lesions and the complex adjacent anatomical structures.Conclusion Virtual colonoscopy based on 64-slice CTA,when combined with 3D reconstruction technique,allows accurate display of the colonic lesions and potential metastasis,which can be crucial for clinical staging and surgical planning of colonic cancer.