中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2014年
10期
607-611
,共5页
血吸虫病%结直肠%肠肿瘤%体层摄影术,X线计算机
血吸蟲病%結直腸%腸腫瘤%體層攝影術,X線計算機
혈흡충병%결직장%장종류%체층섭영술,X선계산궤
Schistosomiasis%Intestine,large%Intestinal neoplasms%Tomography,X-ray computed
目的 回顾性分析血吸虫肠病合并结直肠癌的CT表现,旨在提高对该病诊断的准确性.方法 2007年1月至2012年12月同济大学附属同济医院和昆山市中医院收治的80例经病理学检查证实为血吸虫肠病合并结直肠癌患者,均行腹部CT平扫十增强扫描,由两名放射科医师采用盲法阅片,对病灶部位、形态、大小,钙化特点及强化方式,有无转移进行评估;同时收集同一地区非血吸虫结直肠癌患者20例作为对照.结果 80例血吸虫肠病合并结直肠癌患者的肿瘤以降结肠、乙状结肠和直肠为主,表现为管壁不规则增厚,伴软组织团块,累及肠管长度为(21.35±4.50) cm;其中单发病灶68例(85.0％),多发病灶12例(15.0％),表现为多节段肠管受累;肿瘤组织均可见不同形态的钙化灶,钙化发生比例为100.0％,主要表现为线状、斑点状及小斑片状钙化影,其中59例(73.8％)钙化边缘模糊,21例(26.2％)钙化边缘较清晰;增强早期68例(85.0％)病灶明显强化,均匀强化45例(56.2％),不均匀强化23例(28.8％),增强晚期73例(91.2％)持续强化,坏死少见;仅2例(2.5％)伴发肝脏转移瘤,均无淋巴结转移.20例非血吸虫结直肠癌患者肿瘤均为单发病灶(100.0％),表现为肠壁不规则增厚,伴局部溃疡形成,累及肠管长度为(6.90±3.40) cm;肿瘤组织内均未见钙化影;均表现为增强早期病灶明显不均匀强化,可见低密度坏死区存在,增强晚期不同程度降低;4例(20.0％)伴发肝脏转移瘤.与非血吸虫结直肠癌患者比较,血吸虫肠病合并结直肠癌患者多发病灶的比例较高(x2=100,P=0.000),病变管壁长度较长(t=45.506,P=0.000),钙化灶发生比例较高(x2=100,P=0.000),增强早期病灶明显不均匀强化比例较低(x2 =88,P=0.000),晚期病灶持续强化比例较高(x2=100,P=0.000);肝脏转移发生比例较低(x2 =8.688,P=0.014).结论 血吸虫肠病合并结直肠癌在CT上特征性表现为瘤组织内不同形态钙化影,钙化边缘模糊,并累及多节段肠管;血道转移及淋巴道转移均少见.
目的 迴顧性分析血吸蟲腸病閤併結直腸癌的CT錶現,旨在提高對該病診斷的準確性.方法 2007年1月至2012年12月同濟大學附屬同濟醫院和昆山市中醫院收治的80例經病理學檢查證實為血吸蟲腸病閤併結直腸癌患者,均行腹部CT平掃十增彊掃描,由兩名放射科醫師採用盲法閱片,對病竈部位、形態、大小,鈣化特點及彊化方式,有無轉移進行評估;同時收集同一地區非血吸蟲結直腸癌患者20例作為對照.結果 80例血吸蟲腸病閤併結直腸癌患者的腫瘤以降結腸、乙狀結腸和直腸為主,錶現為管壁不規則增厚,伴軟組織糰塊,纍及腸管長度為(21.35±4.50) cm;其中單髮病竈68例(85.0％),多髮病竈12例(15.0％),錶現為多節段腸管受纍;腫瘤組織均可見不同形態的鈣化竈,鈣化髮生比例為100.0％,主要錶現為線狀、斑點狀及小斑片狀鈣化影,其中59例(73.8％)鈣化邊緣模糊,21例(26.2％)鈣化邊緣較清晰;增彊早期68例(85.0％)病竈明顯彊化,均勻彊化45例(56.2％),不均勻彊化23例(28.8％),增彊晚期73例(91.2％)持續彊化,壞死少見;僅2例(2.5％)伴髮肝髒轉移瘤,均無淋巴結轉移.20例非血吸蟲結直腸癌患者腫瘤均為單髮病竈(100.0％),錶現為腸壁不規則增厚,伴跼部潰瘍形成,纍及腸管長度為(6.90±3.40) cm;腫瘤組織內均未見鈣化影;均錶現為增彊早期病竈明顯不均勻彊化,可見低密度壞死區存在,增彊晚期不同程度降低;4例(20.0％)伴髮肝髒轉移瘤.與非血吸蟲結直腸癌患者比較,血吸蟲腸病閤併結直腸癌患者多髮病竈的比例較高(x2=100,P=0.000),病變管壁長度較長(t=45.506,P=0.000),鈣化竈髮生比例較高(x2=100,P=0.000),增彊早期病竈明顯不均勻彊化比例較低(x2 =88,P=0.000),晚期病竈持續彊化比例較高(x2=100,P=0.000);肝髒轉移髮生比例較低(x2 =8.688,P=0.014).結論 血吸蟲腸病閤併結直腸癌在CT上特徵性錶現為瘤組織內不同形態鈣化影,鈣化邊緣模糊,併纍及多節段腸管;血道轉移及淋巴道轉移均少見.
목적 회고성분석혈흡충장병합병결직장암적CT표현,지재제고대해병진단적준학성.방법 2007년1월지2012년12월동제대학부속동제의원화곤산시중의원수치적80례경병이학검사증실위혈흡충장병합병결직장암환자,균행복부CT평소십증강소묘,유량명방사과의사채용맹법열편,대병조부위、형태、대소,개화특점급강화방식,유무전이진행평고;동시수집동일지구비혈흡충결직장암환자20례작위대조.결과 80례혈흡충장병합병결직장암환자적종류이강결장、을상결장화직장위주,표현위관벽불규칙증후,반연조직단괴,루급장관장도위(21.35±4.50) cm;기중단발병조68례(85.0％),다발병조12례(15.0％),표현위다절단장관수루;종류조직균가견불동형태적개화조,개화발생비례위100.0％,주요표현위선상、반점상급소반편상개화영,기중59례(73.8％)개화변연모호,21례(26.2％)개화변연교청석;증강조기68례(85.0％)병조명현강화,균균강화45례(56.2％),불균균강화23례(28.8％),증강만기73례(91.2％)지속강화,배사소견;부2례(2.5％)반발간장전이류,균무림파결전이.20례비혈흡충결직장암환자종류균위단발병조(100.0％),표현위장벽불규칙증후,반국부궤양형성,루급장관장도위(6.90±3.40) cm;종류조직내균미견개화영;균표현위증강조기병조명현불균균강화,가견저밀도배사구존재,증강만기불동정도강저;4례(20.0％)반발간장전이류.여비혈흡충결직장암환자비교,혈흡충장병합병결직장암환자다발병조적비례교고(x2=100,P=0.000),병변관벽장도교장(t=45.506,P=0.000),개화조발생비례교고(x2=100,P=0.000),증강조기병조명현불균균강화비례교저(x2 =88,P=0.000),만기병조지속강화비례교고(x2=100,P=0.000);간장전이발생비례교저(x2 =8.688,P=0.014).결론 혈흡충장병합병결직장암재CT상특정성표현위류조직내불동형태개화영,개화변연모호,병루급다절단장관;혈도전이급림파도전이균소견.
Objective To retrospectively analyze computerized tomography (CT) imaging features of colorectal cancer with chronic schistosomiasis in order to improve the diagnostic accuracy.Methods Eighty patients whose diagnosis was pathologically confirmed as colorectal cancer with schistosomiasis were collected from Tongji Hospital and Kunshan Chinese Medicine Hospital from January 2007 to December 2012.All the patients underwent abdominal plain CT and contrast-enhanced CT scan.The lesion location,morphology,size,calcification features,enhancement patterns and cancer metastasis were evaluated and compared by two radiologists who were blind to the diagnosis.Twenty colorectal cancer cases without schistosomiasis from the same area were also collected as controls.Results CT imaging showed that the tumors all occurred in the colon and rectum in 80 patients,mainly in colon descendens,colon sigmoideum and rectum.The lesion was characterized by irregular bowel wall thickening with soft tissue masses,and the average length of impaired intestine was (21.35 ± 4.50) cm.The lesions were solitary in 68 cases (85.0％) and were multifocal in 12 cases (15.0％).Linear,spotty and small patchy calcifications were seen in all the patients,with margins unclear in 59 patients (73.8％) and margins clear in 21 patients (26.2％).Early phase enhancement was seen in 68 cases (85.0％),of which 45 cases (56.2％) had homogenous enhancement and 23 cases (28.8％) had heterogeneous enhancement.Late phase enhancement was seen in 73 cases (91.2％) and necrosis was hardly seen.Only two cases (2.5％) had liver metastasis without lymphatic metastasis.All the 20 colorectal cancer cases without schistosomiasis presented with single lesion,which was characterized by irregular bowel wall thickening and local ulcer.The average length of impaired intestine was (6.90±3.40) cm.No calcification was seen in these lesions.All cases had early phase lesion with remarkable heterogeneous enhancement with low density necrotic area.The late phase enhancement was decreased.Four cases (20.0％) had liver metastasis.Compared to cases without schistosomiasis,cases with schistosomiasis tended to have multifocal (x2=100,P=0.000) and longer lesion (t=45.506,P=0.000),and more calcification (x2=100,P=0.000).The early phase heterogeneous enhancement was less frequent (x2 =88,P=0.000) and late phase enhancement was more frequent (x2=100,P=0.000).The liver metastasis rate was significantly lower (x2 =8.688,P =0.014).Conclusions The CT imaging of colorectal cancer with schistosomiasis is characterized by calcifications inside the tumor with obscured margins and multiple intestinal segments involvement.Hematogenous metastasis and lymphatic metastasis are rarely seen.
