经直肠腔内超声造影在直肠癌T分期中的应用价值

Applicative value of transrectal contrast enhanced ultrasound in T-Staging of rectal cancer

目的 探讨经直肠腔内超声造影（CEUS）在直肠癌T分期中的的应用价值. 方法 对我院2012年5月至2013年12月24例直肠癌患者术前行腔内常规超声检查和超声造影检查,观察病灶造影早期、晚期的增强水平、分布特征和增强模式,参考uT（u代表超声）分期标准进行术前分期诊断,并将诊断结果与术后病理结果进行对比. 结果 直肠癌超声造影开始增强时间为14～35 s,造影早期肿瘤呈不均匀团状、带状或环状高增强;晚期造影肿瘤呈不均匀地增强并持续全程观察时间.24例患者中,常规经直肠腔内超声诊断直肠癌T分期总的准确率为66.7％（16/24）,超声造影诊断直肠癌T分期总的准确率为83.3％（20/24）,两者差异有统计学意义（x2＝4.321,P＝0.018）.CEUS诊断直肠癌T1期敏感度、准确率、阳性预测值分别为100.0％（2/2）、100.0％（2/2）、100.0％（2/2）;T2期为83.3％（10/12）、83.3％（10/12）、100.0％ （10/10）;T3期为100.0％（8/8）、88.9％（8/9）、88.9％（8/9）;T4期为100.0％（2/2）、100.0％（2/2）、100.0％（2/2）. 结论 直肠癌超声造影具有典型的声像图表现,比常规经直肠腔内超声更能敏感地显示直肠癌的微血管,能更清晰地显示病灶大小、边界、浸润范围,明显提高直肠癌术前T分期诊断的准确性.

Objective To explore the applicative value of contrast enhanced ultrasound （CEUS） through rectumin the T-staging of rectal cancer.Methods 24 cases with rectal cancer were examined preoperatively by endorectal ultrasound （ERUS） and CEUS during May 2012 to November 2013 in our hospital.The characteristics of contrast enhanced ultrasound imaging in early and late phase of the rectal cancers were studied,and the imaging distribution and enhancement mode were observed.The preoperative staging diagnosis was conducted by consulting T staging criteria.The diagnostic results were compared with the postoperative pathologic diagnosis.Results The contrast enhanced time in rectal cancer began at 14-35s.The early tumor showed uneven nodular,ribbon or ring in high enhancement.At the advanced late,angiographic tumor showed homogeneous enhancement and continued to be observed during the whole time.Normal rectal wall ultrasonography showed spotty low enhancement or no enhancement.The overall accuracy of ERUS in T-staging was 66.7％ （16/24） and the overall accuracy of CEUS was 83.3％ （20/24） respectively.There was a significant difference in the overall accuracy between ERUS and CEUS （P＝0.018）.The sensitivity,accuracy and positive predictive value of CEUS were 100.0％ （2/2）,100.0％ （2/2）,100.0％ （2/2） inT1 stage,83.3％ （10/12）,83.3％ （10/12）,100.0％ （10/10） in T2 stage,100.0％ （8/8）,88.9％ （8/9）,88.9％（8/9） in T3 stage,and 100.0％ （2/2）,100.0％（2/2）,100.0％ （2/2） in T4 stage,respectively.Conclusions As compared toroutine transrectal ultrasound,transrectal contrast enhanced ultrasound imaging on rectal cancer shows the typical sonographic characteristic imaging on microvascular focus size and borders,on characteristic infiltration zone.Therefore,contrast enhanced ultrasound improves the diagnostic accuracy of preoperative T-staging in rectal cancer surgery.