64层螺旋CT显示肿瘤血管征与结直肠管状-绒毛状腺瘤恶变关系的研究

An Initial Study of Tumor-vessel Signs in Malignant Change of Tubulovillous Adenoma on 64-slice Spiral CT

目的探讨64层螺旋CT显示肿瘤血管征与结直肠管状-绒毛状腺瘤恶变的相关性。方法回顾性分析2010年2月-2012年10月16例经手术病理证实的结直肠管状-绒毛状腺瘤及腺瘤恶变患者的影像和临床资料,在影像归档和通信系统工作站中应用多平面重组(MPR)及最大密度投影(MIP)观察肿瘤血管征的显示情况。结果 16例患者中,肿瘤直径≤2 cm者2例,均未见肿瘤血管征显示;肿瘤直径>2 cm者14例,13例见肿瘤血管征显示;肿瘤血管显示与肿瘤的大小有一定相关性(r=0.618,P=0.002)。且肿瘤血管征在肿瘤良恶性间的表现有一定的差异:腺瘤组,显示静脉期血管征,血管走形柔和、自然;腺癌组,显示动脉期血管征,血管粗细不均,可见局限性扩张及不规则缺损表现。不同恶性程度腺癌肿瘤血管征的显示,影像学分析未见明确差异。结论 64层螺旋CT结合MPR、MIP等图像重建技术能够清楚显示肿瘤内部的血供情况,动脉期肿瘤血管征提示结直肠管状-绒毛状腺瘤恶变的风险较高。

Objective To investigate the correlation between tumor-vessel signs on 64-slice spiral CT （MSCT） and malignant change of tubulovillous adenoma in the colon and rectum. Methods A retrospective study of the image and the clinical data of 16 patients with tubulovillous adenoma or malignant change proved by pathologies from February 2010 to October 2012 was conducted. The tumor-vessel signs were analyzed by multiplanar reformation （MPR） and maximum intensity projection （MIP） on picture archiving and communication systems workstation. Results Among the 16 cases of tubulovillous adenoma or malignant change, 2 cases of tumor diameter ~ 2 cm had no tumor-vessel sign; and in the 14 cases of tumor diameter 〉 2 cm, 13 were observed to bear tumor-vessel signs. The size of the tumor and tumor-vessel signs showed a certain correlation （r=0.618, P=0.002）. And the manifestation of tumor-vessel signs had obvious differences between benign and malignant tumor. For the adenoma group, it showed venous blood vessel involvement, and downy and natural contour; for the adenocarcinoma group, it showed arterial blood vessel involvement, blood vessels with uneven thickness, visible expansion and irregular defect manifestations. No obvious difference was detected among tumor-vessel signs of adenocarcinoma with different malignant degree. Conclusion MSCT combined with image reconstruction techniques （such as MPR and MIP） can dearly demonstrate tumor blood supply, and tumor- vessel in the arterial phase may suggest a high risk of malignant change of tubulovillous adenoma in the colon and rectum.