直肠低张充气多层螺旋CT检查对直肠癌术前新辅助治疗疗效的评价

Evaluation of rectum cancer neoadjuvant therapy using MSCT hypotonic air inflation of rectum

目的:探讨直肠低张充气多层螺旋CT检查对直肠癌术前新辅助治疗疗效的评价。方法:回顾性分析33例经手术病理证实的直肠癌新辅助治疗前后直肠低张充气多层螺旋CT影像表现。从肿瘤所在肠壁厚度、肿瘤累及肠管周径的范围、累及肠管的长度范围、增强表现、侵犯层次、管周筋膜情况、管周淋巴结有无肿大、T分期进行分析判断。结果:新辅助治疗前后直肠低张充气多层螺旋CT检查对直肠肿瘤病变均显示良好,新辅助治疗前肿瘤部位肠壁厚度:4～10mm 7例;11～30mm 15例;31mm以上11例;累及肠管周径:1/3以内6例,1/3～1/2 11例,1/2以上未达全周8例,全周径8例。累及肠管长度:10mm以内4例;10～30mm有8例;30～50mm 14例;50mm以上7例。均为中度强化。侵犯黏膜层及黏膜下层7例;浆膜层15例;突破浆膜层11例。11例累及管周脂肪及筋膜。管周、腹腔及腹膜后淋巴结肿大15例;远处转移4例。T1期15.15%,T2期30.30%,T3期42.42%,T4期12.12%。新辅助治疗后肠壁厚度正常10例,4～10mm 5例;11～30mm 10例;31mm以上8例。累及肠管周径1/3以内15例;1/3～1/2 12例;1/2以上未达全部周径6例。累及肠管长度10mm以内13例;10～30mm 6例;30～50mm 10例;50mm以上4例。均为轻度强化。侵犯黏膜层及黏膜下层10例;浆膜层17例;突破浆膜层6例。管周脂肪及筋膜受累3例。管周、腹腔及腹膜后淋巴结肿大6例;远处转移2例。新辅助治疗后T分期变化为:T0期30.30%,T1期24.24%,T2期30.30%,T3期9.09%,T4期6.06%。结论:直肠低张充气多层螺旋CT检查可以对直肠癌新辅助治疗前后直肠癌作出良好的分期,能够正确判断直肠癌新辅助治疗后直肠癌的降期情况。

Objective： To evaluate rectum cancer preoperative neoadjuvant therapy using hypotonic rectal air inflation MSCT.Methods： Imaging findings in 33 cases of pathologically confirmed colorectal cancer after neoadjuvant therapy were analyzed retrospectively.The assessment included： intestinal wall thickness at tumor site,the extent of tumor invlovement of intestinal circumference,the length of intestinal tumor,the features after enhancement,the peri-vascular fascia,lymph node enlargement,and T stage of tumor.Results： Hypotonic rectal air inflation MSCT pre-and post-neoadjuvant therapy can show the rectal lesion satisfactorily.Before therapy： the intestinal wall thickness at the tumor site was 4～10mm in 7 cases,11～30mm in 15 cases,beyond 31mm in 11 cases.Involvement of the intestinal circumference： less than 1/3 in 6 cases,1/3～1/2 in 11 cases,more than 1/2 less than whole circumference in 8 cases,whole circumferential involvement in 8 cases.The length of invlovement： less than 10mm in 4 cases,10～30mm in 8 cases,30～50mm in 14 cases,more than 50mm in 7 cases.All cases had moderate enhancement.Invasion of mucosal and submucosal layer in 7 cases,invasion of serosa in 15 cases,invasion beyond serosa in 11 cases.In 11 cases the peri-intestinal fatty tissue and fascia were invaded.Peri-intestinal,peritoneal and posterior peritoneal cavity lympy node enhargement were seen in 15 cases.Distant metastases in 4 cases.Occurrence of T1 stage was 15.15%,T2 stage was 30.30%,T3 stage was 42.42%,T4 stage was 12.12%.After therapy： the intestinal wall thickness became normal in 10 case,4～10mm in 5 cases,11～30mm in 10 cases,beyond 31mm in 8 cases,involvement of intestinal circumference less than 1/3 in 15 cases,more than 1/3 less than 1/2 in 12 cases,more than 1/2 less than whole circumference in 6 cases.Tumor length less than 10mm in 13 cases,10～30mm in 6 cases,30～50mmin 10 cases,beyond 50mm in 4 cases.All cases had mild enhancement.Invasion of mucosal and submucosal layer were seen in 10 cases,invasion of serosa layer in 17 cases,invasion beyond serosa in 6 cases.Peri-intestinal fatty tissue and fascia involvement in 2 cases.Peri-intestinal,peritoneal cavity and post-peritoneal cavity lymph node enlargement seen in 6 cases.Distant metastases were seen in 3 cases.After neoadjuvant therapy the changes of T stage were： T0 stage 30.30%,T1 stage 24.24%,T2 stage 30.30%,T3 stage 9.09%,T4 stage 6.06%.Conclusion： Hypotonic rectal air inflation MSCT is useful in evaluating the effect of neoadjuvant therapy and can accurately assessing the changes of T staging pre-and post-therapy.