超声造影、CT和MRI对大肠癌肝转移的评估价值比较

Comparison of Evaluation Value of Contrast- Enhanced Ultrasound,CT and MRI on Colorectal Liver Metastases

目的探讨超声造影、CT和MRI对大肠癌肝转移的评估价值的差异。方法采用超声造影、CT和MRI对2013年1月至2014年1月期间我院收治的疑伴肝转移的大肠癌患者88例进行肝转移情况检查。以实验室检查结合肿瘤声学造影等结果为金标准,分析超声造影、CT和MRI诊断大肠癌肝转移的准确性。统计超声造影、CT和MRI显示大肠癌肝转移灶的数目、大小及大肠癌肝转移超声造影特点。结果超声造影、CT和MRI诊断大肠癌肝转移的敏感度、特异度、准确性、Kappa值等比较差异无统计学意义（P〉0.05）。CT和MRI显示总病灶数和病灶大小比较差异无统计学意义（P〉0.05）。CT显示最小病灶体积大于超声造影和MRI,超声造影显示的总病灶数及0～1 cm和1～3 cm转移灶数较CT和MRI增加,超声造影可更好的显示较小转移灶,差异有统计学意义（P〈0.05）。79例肝转移138个重点观察转移病灶超声灌注呈环状增强、团状增强、延迟增强和无增强4个特征,各特征患者比例分别为77.22%、13.92%、2.53%和6.33%,其中团状增强开始增强时间和消退时间最短,其次为环状增强,延迟增强开始增强时间和消退时间均较长,差异有统计学意义（P〈0.05）。结论超声造影、CT和MRI诊断大肠癌肝转移准确性均较高,其中超声造影更有利于肝转移灶数目、部位、大小等的确认,可有效显示微小转移灶,为大肠癌临床分期和治疗提供有力依据,值得临床推广使用。

Objective To investigate the evaluation value of Contrast- enhanced ultrasound,CT and MRI on colorectal liver metastases. Methods Contrast- enhanced ultrasound,CT and MRI were used to evaluate the liver metastasis of 88 patients with colorectal cancer in our hospital from January,2013 to January,2014. Laboratory tests combined with acoustic imaging results were taken as the gold standard,and the evaluation value of Contrast- enhanced ultrasound,CT and MRI on colorectal liver metastases were compared. The number and size of colorectal liver metastases measured by contrast- enhanced ultrasound,CT and MRI and the ultrasonic imaging features of colorectal liver metastases were statistically analyzed. Results accuracy,sensitivity,specific degrees and Kappa value of contrast- enhanced ultrasound,CT and MRI in the diagnosis of colorectal liver metastases had no statistical significant differences（ P〉0. 05）. Total number of liver metastases measured by CT and MRI showed no statistical significant differences（ P〉0. 05）. CT demonstrating the focal area of minimum volume was greater than that of the ultrasonic imaging and magnetic resonance imaging（ MRI）; the total number of liver metastases and liver metastases in 0 to 1 cm and 1 to 3 cm size measured by ultrasound imaging metastases were higher than that of the CT and MRI,contrast- enhanced ultrasound can better show small metastases of colorectal cancer; and the difference was statistically significant（ P〈0. 05）. patients rate of patients showed 138 key observation metastatic lesions in 79 cases of colorectal cancer patients with liver metastasis showed ultrasound perfusion characteristics as rimlike enhancement,regimental enhancement,delayed enhancement and no enhanced images were 77. 22%,13. 92%,2. 53% and 6. 33%;rimlike enhancement had shortest time to begin to enhance strengthen and fade,regimental enhancement followed by rimlike enhancement,delayed enhancement start had longer time to begin to enhance strengthen and fade; and the difference was statistically significant（ P〈0. 05）. Conclusion Evaluation value of contrast- enhanced ultrasound,CT and MRI in the diagnosis of colorectal liver metastases accuracy was high. The ultrasonic imaging can better show liver metastases number,location,size,etc,and small liver metastases so as to provide powerful basis for clinical staging and treatment of colorectal cancer.