大肠癌的CT分期与手术病理对照

CT evaluation of colorectal carcinoma correlation in operation and histopathology

目的 :探讨大肠癌CT分期的价值与限度。方法 :回顾性分析一组 46例大肠癌 48个病灶的术前CT资料 ,与手术及病理分期对照 ,观察大肠癌术前CT分期的敏感性 ,准确性。结果 :46例大肠癌 48个病灶中 ,33个局部肿瘤突破浆膜层 (T4) ,CT正确诊断 31个 ,表现为肠壁外缘不光整伴线样影伸向周围脂肪组织或结节样突出或肠周脂肪密度增高。 40例行根治性切除 ,其中 2 0例病理证实淋巴结转移 ,1 7例转移淋巴结大小未超过 1cm ;CT检出转移淋巴结敏感性 70 % (1 4 / 2 0 ) ,特异度 85 % (1 7/ 2 0 )。本组CTT、N分期准确率分别为 81 .2 5 %、77.50 % ,远处转移显示率高 ,肝 4/ 4 ,腹膜 6/ 7。结论 :CT对大肠癌T4期的判断准确度高 ,肠旁侵犯范围显示佳 ,是发现大肠癌远处转移的有效手段 ,但对T1～

Purpose:To assess the value and limitation of CT in staging colorectal carcinoma.Methods:CT was performed prior to surgery in 46 patients with 48 colorectal carcinomas for staging the tumor. The results were compared with those of surgical and pathological examinations in all cases in order to study the sensitivity of staging the tumor before operation.Results:(1) CT depicted 31 of 33 pathologically confirmed T4 lesions (beyond the serosa) in all 48 primary carcinomas,appearance of T4 lesion were defined as either strands of soft tissue or nodules into the peri-colorectal fat ,or hyperdensity of pericolorectal fat. (2)Pathologic examination of lymphatic metastases unfirmed 20 of 40 patients who underwent complete resections, and these lymph nodes were not larger than 1cm in 17 patients.The sensitivity is 70%(14/20)and the specificity 85%(17/20)respectively in detection of lymphatic metastases for CT. (3) The accuracy of CT staging was 81.25%,77.50% in T,N respectively in this group of patients,and CT showed all 4 cases of liver metastases and 6 of 7 peritoneal metastases. Conclusions:CT is accurate in detecting T4 stage of colorectal carcinoma. It is effective in depicting local extension and distant metastases. The value of CT for early T staging and N staging in colorectal carcinoma is limited.