结肠癌肝转移的螺旋CT特征及临床价值

Special Findings and Clinical Value of Spiral CT in Hepatic Metastases from Colorectal Cancer

目的 评价螺旋CT对于结肠癌肝转移术前检出与可切除性评估价值。方法 螺旋CT扫描对 10 0例肝转移病例进行术前分期 ,层厚 5mm ,重建间隔 5mm ;以 2 .0～ 3 .0ml/s速率静脉注入 10 0ml含碘造影剂后 60～ 70s后开始扫描。螺旋CT征象与手术及病理所见按病灶逐一对照。结果 触诊与病理学检查揭示了 184个肝转移灶 ,螺旋CT扫描正确预测了其中的 15 6个 ,总体检出率 84.8% ,阳性预测值 96.0 % ,假阳性率 3 .8% ( 7/ 184)。在 72例患者的 76例次手术中 ,71例次为可治愈切除 ,可切除率为 93 .4% ( 71/ 76)。病例五年生存率为 5 4.2 %。结论 螺旋CT扫描应被看作是结肠癌肝转移的标准或最佳术前检出方法。

Objective To evaluate the value of spiral computed tomography (CT) in the preoperative detection of hepatic metastases and assessment of resectability. Methods During 1995-2002, preoperative staging with spiral CT was performed in 100 patients with hepatic metastases. Iodinated contrast material was injected intravenously (100ml; rate, 2-3ml/s). The scan was started at 60-70 seconds after the injection. Spiral CT findings were correlated with pathologic and surgical findings on a lesion by lesion basis. Results Palpation and histopathology examinations revealed 184 liver metastases; spiral CT correctly depicted 156 of them. Spiral CT results were as the following: overall detection rate was 84.8%; positive predictive value was 96.0%; and false positive rate was 3.8% (7/184). Resection was recommended in 76 instances(72 cases) and curative resection was performed in 71 instances with a resectability rate of 93.4%(71/76). Five year survival rate was 54.2%. Conclusion Spiral CT should be considered as the standard preoperative work up of hepatic metastases from colorectal cancer. [