64排螺旋CT仿真结肠镜在结肠癌诊断中的应用

Clinical application of 64-slice spiral CT virtual colonoscopy in diagnosis of colonic carcinoma

目的探讨64排螺旋CT仿真结肠镜(CT virtual colonoscopy,CTVC)及其二维三维重建在结肠占位的CT表现及临床应用。方法回顾分析52例行64排螺旋CT双体位结肠扫描的结肠癌病例,所有患者均进行结肠充气仰卧位及俯卧位增强扫描,其中20例增加了左或右侧位三期扫描,将MSCT扫描原始数据传送至ADW4.4工作站采用CT仿真结肠镜(CTVC)、多平面重建(MPR)、表面遮盖显示(SSD)、透明重建显示(Raysum)4种方法进行结肠重建处理,对病灶的形态、大小、密度、结肠壁受损的程度、范围以及结肠外情况、淋巴结转移情况进行综合分析,做出准确判断。结果结肠、直肠癌52例,全部病例均经过手术及纤维结肠镜检查活检病理证实。结论 MSCT仿真结肠镜可显示结肠占位病变的形态、大小及肠壁、肠周侵犯情况,多体位扫描能使病变肠管扩张充分,更好地显示病灶的细节,提高病变检出的敏感性,为临床选择合理的治疗提供有价值的依据,是诊断结肠占位的一种有效检查方法。

Objective To investigate the CT manifestations and diagnostic value of 64 - slice spiral CT virtual colonoscopy （CTVC） and its 2D/3D - restruction in colonic neoplasms. Methods 64 - slice spiral CT scan of colon was performed in 52 patients, Spiral CT enhancing scan was performed in both the supine and prone positions after appropriately distended by introduction of air and water, and triple -phase spiral CT enhanced scan were additionally performed in 20 of 52 cases, and the data of MSCT were transferred to ADW4.4 workstation for colon reconstruction image post processing including CT virtual colonoscopy （CTVC）, multiple planar reconstruction （MPR）, shaded surface display （SSD） and Raysum display. The MSCT findings of the shape, size and density of lesions, the injury extent and range of colonic wall and extracolon, and lymph node metastasis were analyzed and estimated. Results Totally 52 cases of colonic and rectal carcinoma were founded, all cases were confirmed by operative and colonoscopic biopsy pathology. Conclusions MSCT virtual colonoscopy can clearly display the shape and size of lesions, the invasion of colonic wall and pericolonic tissues. Use of multi - positions scanning can obviously make the bowel dilated and more clearly display the lesions, and improve imaging effect and detection rate of CT virtual colonoscopy for colonic masses. MSCTVC is a valuable tool in the assessment and diagnosis of colonic neoplasms.