术前多层螺旋CT检查对结直肠癌旁肿瘤沉积的诊断应用价值

Value of preoperative multi-slice spiral CT in the diagnosis of tumor deposition adjacent to colorectal cancer

目的:探讨术前多层螺旋CT(multi slice spiral computed tomography,MSCT)检查对结直肠癌旁肿瘤沉积(tumor deposition,TD)的诊断应用价值。方法:回顾性分析经手术病理证实存在TD的50例结直肠癌患者的术前全腹部MSCT影像学资料,观察TD的影像学特征,测量TD和同区域转移淋巴结的多项参数值,对TD和转移淋巴结的CT影像学特征和相关测量参数进行比较分析。结果:在50例结直肠癌患者中,证实TD病灶78个,转移淋巴结35个。TD病灶距原发肿瘤(2.63±0.70)cm,主要位于结直肠周围脂肪间隙,占91.03%;形态多不规则,呈分叶征或边缘毛刺征,占82.05%;67个TD病灶平扫密度均匀,双期增强扫描强化明显,与原发肿瘤强化程度接近;11个TD病灶可见液化坏死。转移淋巴结病灶形态较规则,边缘较光滑,外形圆润,多呈圆形或椭圆形,占88.57%。MSCT相关参数比较:TD病灶长径、短径、最大径均长于转移淋巴结,平扫CT值、动脉期强化CT值和静脉期强化CT值高于转移淋巴结,差异有统计学意义(P<0.05);TD病灶与原发肿瘤病灶CT值比较,差异无统计学意义(P>0.05)。结论:术前MSCT检查能显示结直肠癌旁TD的多种影像学特征,有助于临床诊断和鉴别转移淋巴结。

Objective:To investigate the value of preoperative multi slice spiral CT(MSCT)in the diagnosis of tumor deposition(TD)adjacent to colorectal cancer.Methods:The preoperative whole abdominal MSCT data of 50 patients with colorectal cancer confirmed by surgery and pathology were retrospectively analyzed.The imaging characteristics of TD were observed,and the parameters of TD and metastatic lymph nodes in the same region were measured.The CT imaging characteristics and related measurement parameters of TD and metastatic lymph nodes were compared and analyzed.Results:Among the 50 patients with colorectal cancer,78 TD lesions and 35 metastatic lymph nodes were confirmed.TD lesions were(2.63±0.70)cm away from the primary tumor,mainly located in the fat space around the colorectal,accounting for 91.03%;most of the lesions were irregular in shape,showing lobulated sign or edge burr sign,accounting for 82.05%;67 TD lesions had uniform density on plain scan,obvious enhancement on dual phase enhanced scan,which was close to the enhancement degree of the primary tumor;11 TD lesions had liquefaction necrosis.The metastatic lymph node lesions were regular in shape,with smooth edge,and mostly round or oval,accounting for 88.57%.Comparison of MSCT related parameters:the long diameter,short diameter and maximum diameter of TD lesions were longer than those of metastatic lymph nodes,and the CT value of plain scan,arterial phase enhanced CT value and venous phase enhanced CT value were higher than those of metastatic lymph nodes(P<0.05);there was no statistically significant difference in CT value between TD lesions and primary tumor lesions(P>0.05).Conclusion:Preoperative MSCT examination can show a variety of imaging features of TD adjacent to colorectal cancer,which is helpful for clinical diagnosis and differential diagnosis of metastatic lymph nodes.