螺旋CT对结直肠癌术前分期的评价

Spiral CT in the preoperative staging of colorectal carcinoma-radiologico-pathologic correlation

目的 探讨螺旋CT(SCT)对结、直肠癌术前分期的价值。方法 5 1例疑诊结、直肠肿瘤的患者行SCT扫描 ,扫描前清洁肠道 ,并经直肠注气 ,扫描范围从膈顶至耻骨联合。 5 1例中 ,41例经结肠镜或手术病理证实为结、直肠癌 (含腺瘤恶变 2例 ) ,其中 31例有手术、SCT等完整资料参与分期研究 ,将影像诊断结果与手术病理结果进行对照。结果 SCT总的分期准确率为 5 8.1% (18/ 31)。判断T分期的准确率为 84.4% (2 7/ 32 ) ,N分期的准确率为 6 1.3% (19/ 31)。评价肿瘤浆膜外侵犯的敏感性和特异性分别为 92 .9%和 5 0 .0 %。判断淋巴结转移的敏感性和特异性分别为 70 .0 %和 81.8%。结论 SCT扫描对结、直肠癌的术前分期有重要价值 ,有助于判断肿瘤浆膜外侵犯及区域淋巴结和远处转移情况。

Objective To evaluate spiral CT (SCT) in the preoperative staging of colorectal carcinomas. Methods Fifty-one patients suspicious of having colorectal carcinoma underwent spiral CT scans performed from the dome of the diaphragm to symphysis pubica after cleansing enema and rectal air insufflation. Fourty-one of the 51 patients were proved to have colorectal carcinoma by colonoscopy and/or pathology. The findings of SCT of 31 patients treated with surgery were compared with the surgical pathological examination for staging. Results The overall accuracy rate of SCT staging was 58.1%(18/31). For evaluation of T staging and N staging, the accuracy rates were 84.4%(27/32) and 61.3%(19/31). Sensitivity and specificity for serosal infiltration were 92.9%(26/28) and 50.0%, They were 70.0%(14/20) and 81.8%(9/11) for lymph node involvement. Conclusion SCT scan, playing a significant role in the preoperative staging of colorectal carcinoma, is useful to detect the serosal infiltration, lymph node and distant metastasis.