口服等渗甘露醇肠道CT造影对大肠癌分期的诊断价值

Diagnostic value of oral isosmotic mannitol intestinal CT angiography for staging of colorectal cancer

目的:探讨64排螺旋CT(64-MSCT)结合口服等渗甘露醇溶液肠道CT造影对大肠癌术前TNM分期的价值。方法:34例经手术病理证实的大肠癌患者均行64-MSCT平扫及增强检查,其中15例行口服等渗甘露醇溶液肠道CT造影。通过工作站后处理软件获得多平面重建后处理图像并对每例患者进行术前TNM分期,将影像分期与手术病理分期进行对比,并将口服等渗甘露醇组术前分期与未口服组进行对比。结果:口服甘露醇组T≤2期的敏感度、特异度、Youden指数、阳性预测率、阴性预测率分别为100%、100%、1、100%、100%,T3期分别为100%、83.3%、0.83、90%、100%,T4期分别为75%、100%、0.75、100%、91.7%;未口服组T≤2期敏感度、特异度、Youden指数、阳性预测率、阴性预测率分别为80%、92.9%、0.73、80%、92.9%,T3期分别为81.8%、75%、0.57、81.8%、75%,T4期分别为66.7%、93.8%、0.61、66.7%、93.8%;口服甘露醇组与未口服组N分期及M分期的敏感度、特异度、Youden指数、阳性预测率、阴性预测率差异均无统计学意义(P>0.05)。口服甘露醇组术前T分期Youden指数均明显高于未口服组(P<0.05)。结论:口服等渗甘露醇溶液肠道CT造影可提高肠道与周围的对比,进而更准确地评估大肠癌的术前分期,为临床的诊治提供参考。

Objective: To evaluate the value of 64-MSCT combined with oral isosmotic mannitol intestinal CT angiography in preoperative TNM staging of colorectal cancer. Methods: Thirty-four patients with colorectal cancer confirmed by operation and pathology were examined by 64-MSCT plain scan and enhanced examination,of which 15 patients received intestinal CT angiography with oral isosmotic mannitol solution. Multiplanar reconstruction images were obtained by workstation post-processing software and TNM staging was performed on each patient before operation, and the imaging staging was compared with the operative pathological stage and the preoperative staging in the oral mannitol group and the non-oral mannitol group.Results: The sensitivity, specificity, Youden index, positive predictive rate and negative predictive rate of T ≤ 2 in oral mannitol group were 100%, 100%, 1, 100%, 100% respectively, and 100%, 83.3%, 0.83, 90%, 100% respectively in T3 phase, and 75%, 100%, 0.75, 100%, 91.7% respectively in T4 phase.The sensitivity, specificity, Youden index, positive predictive rate, and negative predictive rate of T≤2 phase in the non-oral mannitol group were 80%, 92.9%, 0.73, 80%, 92.9% respectively, and 81.8%, 75%, 0.57, 81.8%, 75% respectively in T3 phase,and 66.7%, 93.8%, 0.61, 66.7%,93.8% respectively in T4 phase.The preoperative T-staging Youden index of oral mannitol group was significantly higher than that of non-oral mannitol group(P<0.05).There was no significant difference in the accuracy of N and M staging(P>0.05). Conclusions: Oral isosmotic mannitol solution intestinal CT angiography can improve the contrast between the intestinal tract and the surrounding area.Therefore, the preoperative staging of colorectal cancer can be more accurately evaluated, and provide a reference for clinical diagnosis and treatment.