CAJ | 학술논문

目的探讨CT薄层及多平面重建在不同部位和不同病理分期结直肠癌术前T分期中的价值.方法应用64排螺旋CT进行容积数据扫描163例结直肠癌患者,分别以层厚5 mm(间隔5 mm)及0.5 mm(间隔0.4 mm)重建出横断面图像及多平面重建图像(MPR),对病变进行部位及T分期评估.根据发病部位分成3组:Ⅰ组:直肠下段前壁或邻近齿状线;Ⅱ组:直肠下段后壁或侧壁;Ⅲ组:直肠中上段或结肠.将Ⅲ组病例按照术后病理分期分为4组:A组:Tis和T1;B组:T2(B1组:T2a,B2组T2b);C组:T3;D组:T4.对照术后病理结果分析不同部位、不同成像方法及不同病理分期进行T分期的准确率.结果 5 mm对Ⅰ、Ⅱ、Ⅲ组T分期的诊断灵敏度分别为44.44%、61.54%和66.67%;0.5 mm分别为51.85%、61.54%和69.92%;MPR分别为51.85%、76.92% 和78.86%.CT对Ⅰ组与Ⅲ组的诊断准确灵敏度存在显著差异(5 mm P=0.031、MPR P=0.004),Ⅲ组中MPR组优于5 mm和0.5 mm(P=0.008,P=0.019).CT对Ⅲ组A、B、C、D 4亚组的T分期诊断灵敏度如下:5 mm 为53.85%、30.00%(B1组57.14%,B2组6.25%)、84.00%和60.00%;0.5 mm为76.92%、33.33%(B1组76.92%,B2组18.75%)、84.00%和60.00%;MPR分别为92.31%、53.33%(B1组78.57%,B2组31.25%)、86.67%和80.00%.CT对B2组的诊断灵敏度显著低于其他组,且大部分诊断错误病例为高估.结论 CT对早期结直肠癌诊断具有良好的灵敏度、特异度和准确率.MPR可提高CT对中上段直肠及结肠肿瘤的诊断灵敏度.CT对直肠下段前壁或邻近齿状线的直肠癌的T分期灵敏度均较低,对T2b过高诊断是主要原因.
목적 탐토CT박층급다평면중건재불동부위화불동병리분기결직장암술전T분기중적개치.방법 응용64배라선CT진행용적수거소묘163례결직장암환자,분별이층후5 mm(간격5 mm)급0.5 mm(간격0.4 mm)중건출횡단면도상급다평면중건도상(MPR),대병변진행부위급T분기평고.근거발병부위분성3조:Ⅰ조:직장하단전벽혹린근치상선;Ⅱ조:직장하단후벽혹측벽;Ⅲ조:직장중상단혹결장.장Ⅲ조병례안조술후병리분기분위4조:A조:Tis화T1;B조:T2(B1조:T2a,B2조T2b);C조:T3;D조:T4.대조술후병리결과 분석불동부위、불동성상방법 급불동병리분기진행T분기적준학솔.결과 5 mm대Ⅰ、Ⅱ、Ⅲ조T분기적진단령민도분별위44.44%、61.54%화66.67%;0.5 mm분별위51.85%、61.54%화69.92%;MPR분별위51.85%、76.92% 화78.86%.CT대Ⅰ조여Ⅲ조적진단준학령민도존재현저차이(5 mm P=0.031、MPR P=0.004),Ⅲ조중MPR조우우5 mm화0.5 mm(P=0.008,P=0.019).CT대Ⅲ조A、B、C、D 4아조적T분기진단령민도여하:5 mm 위53.85%、30.00%(B1조57.14%,B2조6.25%)、84.00%화60.00%;0.5 mm위76.92%、33.33%(B1조76.92%,B2조18.75%)、84.00%화60.00%;MPR분별위92.31%、53.33%(B1조78.57%,B2조31.25%)、86.67%화80.00%.CT대B2조적진단령민도현저저우기타조,차대부분진단착오병례위고고.결론 CT대조기결직장암진단구유량호적령민도、특이도화준학솔.MPR가제고CT대중상단직장급결장종류적진단령민도.CT대직장하단전벽혹린근치상선적직장암적T분기령민도균교저,대T2b과고진단시주요원인.
Objective To explore the diagnostic value of thin image and multiplanar reconstruction (MPR) for preoperative T staging on different regions and various pathological staging of colorectal cancer. Methods A total of 163 colorectal cancer patients underwent 64-slice CT examination, then cross section image with thickness of 5 mm (5 mm interval) and 0.5 mm (0.4 mm interval) were reconstructed. The lesions were evaluated and T staged with 5 mm, 0.5 mm and MPR image, respectively. Patients were divided according to the region of lesions: groupⅠ: the anterior wall of lower rectal or near dentate line; groupⅡ: the posterior or lateral wall of lower rectal; group Ⅲ: upper middle rectal or clone. Patients in group Ⅲ were divided into 4 subgroups according to postoperative pathological staging: group A: Tis and T1; group B: T2 (B1: T2a; B2: T2b); group C: T3; group D: T4. The accurate diagnostic rates of different regions, different imaging techniques and different pathological staging were analyzed compared with postoperative pathological results. Results CT accurate T staging diagnostic rate for group Ⅰ, Ⅱ, Ⅲ was 44.44%, 61.54% and 66.67% respectively with 5 mm; 51.85%, 61.54% and 69.92% respectively with 0.5 mm; 51.85%, 76.92% and 78.86% with MPR. There was significant difference of CT accurate diagnostic rates only between group Ⅰ and group Ⅲ (5 mm P=0.031, MPR P=0.004). MRP was better then 5 mm and 0.5 mm only in group Ⅲ (P=0.008, P=0.019). The sensibility of diagnostic T staging of A, B, C and D subgroup in group Ⅲ was as follows: 53.85%, 30.00%(B1: 57.14%, B2: 6.25%), 84.00% and 60.00% with 5 mm; 76.92%, 33.33%(B1: 76.92%, B2: 18.75%),84.00% and 60.00% with 0.5 mm; 92.31%, 53.33%(B1: 78.57%, B2: 31.25%), 86.67% and 80.00% with MPR. CT accurate T staging diagnostic rate of subgroup B2 was significantly lower than those of other groups, and most of the errors were over valuated. Conclusion CT has good sensitivity, specificity and accuracy for diagnostic T staging for early colorectal cancer. MPR can raise the accurate diagnostic rate of upper middle rectal and colon tumor. CT diagnostic value for T staging of lesions at the anterior wall of lower rectal or near dentate line tumor is limited, and the primary cause is over diagnosis of T2b lesions.