多层螺旋CT及双期增强扫描对大肠癌术前分期价值研究

目的评价大肠低张充气多层螺旋CT结肠重建成像（multi-slice spiral CT of colon MSCTC），及双期增强扫描在大肠癌术前分期中的应用价值。方法研究35例经纤维内镜检查证实或临床高度怀疑大肠癌患者进行MSCTC及双期动态增强扫描检查。利用MSCTC后处理图像，并结合各期横断面图像，观察肿瘤原发病灶、淋巴结和远处转移情况进行分期（TNM分期），并与手术病理结果对照。结果本组多层螺旋CT研究显示对大肠癌T期敏感性100％（35／35），T期的准确率91．5％（32／35）。N期的敏感性80．0％（16／20），N期准确率75．0％（15／20）。4例肝脏转移经CT检出。结论大肠癌术前MSCTC成像及结合各期横断面图像，能进行准确术前分期，并为临床提供立体准确的影像学信息。     

螺旋CT在直肠癌术前分期中的价值

目的：评价螺旋CT(SCT)在直肠癌术前分期中的价值。方法：对58例直肠癌患者术前行SCT检查。与手术及病理结果对比，观察SCT对直肠肿瘤浸润深度、区域淋巴结转移和远处转移判断的准确性。结果：SCT术前分期总的准确率为65．5％(38／58)，T分期的准确率为81．0％(47／58)，N分期的准确率为67．2％(39／58)，评价肿瘤侵犯外膜的敏感性和特异性分别为97．9％(46／47)和63．6％(7／11)，评价淋巴结转移的敏感性为71．1％(27138)，特异性为60．0％(16／20)。结论：SCT对直肠癌术前判断外膜侵犯、淋巴结转移和远处转移情况有重要价值。     

进展期胃癌术前CT分期的临床价值探讨

对46例进展期胃癌在低张、充盈状态下,进行CT分期并与手术对照。46例胃癌CT扫描准确率为91．30％,对胃周围实质性器官浸润情况有较高敏感性;术中摘除淋巴结67枚（CT显示56枚）,病理证实转移淋巴结49枚（CT显示41枚）,CT诊断准确度70％（14／20）,直径≤0.5cm者准确率50％,直径≥1.0cm者准确率100％,漏误诊率为50％（14／28）。N2站淋巴结敏感性最低为35．71％,N3、N4站淋巴结敏感性较高,分别为54．54％、85．72％。研究结果提示,进展期胃癌术前CT扫描分期对胃癌的手术治疗具有指导意义。     

AFP阳性胃癌的CT表现

目的 总结AFP阳性胃癌(alpha-fetoprotein-producing gastric cancer,AFPGC)的CT表现,评估CT在AFPGC术前分期中的临床价值.方法 由两名放射科医生共同回顾性阅读21例经病理证实的AFPGC术前CT图像,描述原发病灶、脏器受累、淋巴结转移、远处转移、血管侵犯等CT表现,并与病理结果比较,分析其用以术前分期的准确率.结果 21例AFPGC术前CT表现如下:15例(71.4％)原发灶为偏心性胃壁增厚,20例(95.2％)原发灶为不均匀强化,6例(28.6％)脏器侵犯,19例(91.5％)淋巴结转移,6例(28.6％)远处转移,13例(61.9％)血管侵犯.CT对AFPGC术前T分期、N分期、M分期及TNM分期的准确率分别为90.5％、71.4％、71.4％和71.4％.结论 AFPGC的CT影像表现为不均匀强化的偏心性胃壁增厚,有较强的肝转移、淋巴结转移及周围脏器和血管侵犯的倾向.CT能够较准确地判断AFPGC的术前分期.     

胸段食管癌临床分期与病理TNM分期对比研究

目的：探讨胸段食管癌临床分期的准确性并结合病理TNM分期进行对比分析方法：58例可切除胸段食管癌．术前行钡餐造影、胸部CT扫描和腹部超声波检查，根治术后病理均为鳞状细胞癌病理TNM分期：Ⅱa期28例占483％，Ⅱb期2例占3．4％，Ⅲ期27例占46．6％，Ⅳ期1例占1．7％．术前临床分期：Ⅱ期27例占46．6％，Ⅲ期28例占483％，Ⅳ期3例占5．2％采用方差分析和相关性检验统计两种分期的相关性和符合性结果：术后病理T分期与术前临床T分期的相关性不明显r=-0．233，P=0．079；而术后病理N分期与术前临床N分期具有显著性相关r=0．285．P=0．030；病理TNM和临床TNM分期有显著性相关r=0．289，P=0．028术后病理淋巴结转移者30例占51．7％．术前CT片淋巴结肿大者33例占56．9％．二者具有显著性相关r=0．388，P=0．003病理TNM分期和临床TNM分期均呈现分期越晚转移淋巴结个数越多，同样钡餐造影的病变长度也随期别越晚，病变长度越长。且有统计学意义。临床T分期与CT片显示的肿大淋巴结个数和术后病理淋巴结转移个数均具有显著性相关r=0．289，P=0．028和r=0．298．P=0．023，然而病理T分期与淋巴结转移并未显示相关性结论：两种分期系统有一定相关性和符合率，但仍存在较大差距，主要是病变局部T分期在早期病例的符合率较差，内窥镜超声介入可能会有所帮助。     

64排螺旋CT在直肠癌术前分期的诊断价值

目的：评价64排螺旋CT进行直肠癌术前分期的准确性及诊断价值。方法：纳入51例经手术病理检查证实为直肠癌,并在术前行全腹CT扫描的患者,分析CT影像在确定肿瘤侵犯范围、淋巴结转移及远处转移方面的特点,并与病理结果进行对比。结果：64排螺旋CT对直肠癌T分期、N分期、M分期的准确度分别为84．3％（43／51）,84．3％（43／51）,98．0％（50／51）,对直肠癌TNM分期总准确度为74．5％（38／51）。结论：利用64排螺旋CT腹部平扫技术,能够较为准确地进行直肠癌术前分期,有助于临床选择恰当的手术方案和制定有效的综合治疗措施。     

低张水灌肠螺旋CT双期增强扫描对结肠癌术前分期的应用价值

目的探讨低张水灌肠螺旋CT双期增强扫描对结肠癌术前TNM分期的准确性及临床应用价值。方法选择广东省阳春市人民医院2012年1月_2013年5月,有完整影像和病理资料的结肠癌患者62例,回顾性分析CT影像在肿瘤的部位、肠壁侵犯的深度范围、周围脂肪问隙的变化、淋巴结及远处器官转移等特点,并与手术及术后病理对照,分析低张水灌肠螺旋CT双期增强扫描对结肠癌术前TNM分期的准确性。结果低张水灌肠螺旋CT双期增强扫描对结肠癌T分期准确率90．32％（56／62）,N分期准确率80．64％（50／62）,M分期准确率100％（62／62）。结论低张水灌肠螺旋CT双期增强扫描能准确显示结肠癌的部位、确定肿瘤侵犯的深度范围、淋巴结和远处器官转移,更准确的诊断结肠癌和术前分期评估,可以作为结肠癌术前的首选检查方法。     

PET/CT与MRI在鼻咽癌淋巴结转移诊断和N分期中的比较研究

目的 比较PET／CT与MRI在鼻咽癌淋巴结转移诊断和N分期中的作用。方法116例鼻咽癌患者于治疗前行PET／CT和MRI检查。依据随访结果比较PET／CT和MRI在淋巴结转移诊断和N分期中的作用。结果116例患者的614个淋巴结的随访结果显示,阳性340个,阴性274个。PET／CT诊断转移淋巴结的敏感性、特异性及准确性分别为93．2％、98．2％和95．4％,而MRI分别为88．8％、91．2％和89．9％,两者各指标比较,差异有统计学意义（P〈0．05）。按1992年福州分期,109例（94．0％）的PET／CT分期正确,103例（88．8％）的MRI分期正确;按UICC分期,108例（93．1％）的PET／CT分期正确,100例（86．2％）的MRI分期正确。结论PET／CT判断鼻咽癌淋巴结转移和N分期较MRI准确,但对炎性增生、大面积坏死淋巴结,或直径小于PET空间分辨率的转移淋巴结应警惕其假阳性和假阴性判断。     

胃癌孤立淋巴结转移的影像研究

[目的]评价CT在胃癌孤立淋巴结转移中的诊断作用。[方法]回顾性分析胃癌孤立淋巴结转移患者75例临床资料。[结果]75例患者中,68例淋巴结转移位于胃周（N1）。另有7例患者淋巴结跳跃转移至N2～N3站,CT对孤立淋巴结转移胃癌患者T分期、N分期及M分期的准确率分别为73-3％、78．7％和90％。[结论]并非每个前哨淋巴结都位于胃周原发病灶附近。CT在孤立淋巴结转移胃癌患者TNM分期上的准确性较高。     

胃癌术前分期的B超诊断评估

目的：判定进展期胃癌切除的可能性和／或手术方式的选择。方法：本组34例均经Pentax胃镜检查，活检确诊为胃癌，术前应用ATL Apogee800彩色B超应用变频探头对其进行检查，肿瘤的胃壁浸润情况和淋巴结转移情况判定B超TN期，分别与病理TN期比较。结果B超诊断肿瘤大小与手术所见符合率83．3％，T期准确度分别为T2 50％，T3 76．4％，T4 62．5％，总符合率达87．5％，N期准确度N1 80％，N2 75％总符合率75％以上。结论：高性能B超有助于对胃癌的术前分期，对手术切除可能性的判断和转移淋巴结的清除，以及预后有重要价值。     

多层螺旋CT在直肠癌术前分期中的诊断价值

背景与目的:直肠癌术前分期对选择合理治疗方案和判断预后至关重要。传统的计算机断层扫描(computed tomography,CT)对直肠癌术前分期存在争议,本研究旨在探讨多层螺旋CT(multislice spiral CT,MSCT)对直肠癌术前分期的诊断价值。方法:中山大学肿瘤防治中心2006年3月至2007年2月,经病理证实的直肠癌患者87例,所有患者术前行MSCT平扫及增强扫描,由两位放射科医生独立评价肿瘤的部位、大小、侵犯范围(T)、淋巴结转移(N)及远处转移(M)情况,做出诊断及TNM分期,并与术后病理对照,评价准确性、灵敏度及特异度。结果:MSCT检出了全部87例直肠癌,对直肠癌TNM分期总的准确性为81.6%(71/87)。T、N、M期准确性分别为94.3%(82/87)、82.8%(72/87)、98.9%(86/87)。≤T2、T3、T4期灵敏度分别为90.5%、91.3%、97.7%,特异度分别为98.5%、94.2%、97.7%。N0、N1、N2期灵敏度分别为92.9%、72.0%、82.4%,特异度分别为88.9%、88.5%、91.7%。远处转移的患者仅1例因肝脏转移灶<5mm而漏诊。结论:MSCT能较准确地判断直肠癌的侵犯范围、淋巴结转移及远处转移,是非常有价值的术前分期方法。     

螺旋CT对结直肠癌术前分期的评价

目的 探讨螺旋CT（SCT）对结、直肠癌术前分期的价值。方法 51例疑诊结、直肠肿瘤的患者行SCT扫描,扫描前清洁肠道,并经直肠注气,扫描范围从膈顶至耻骨联合。51例中,41例经结肠镜或手术病理证实为结、直肠癌（含腺瘤恶变2例）,其中31例有手术、SCT等完整资料参与分期研究,将影像诊断结果与手术病理结果进行对照。结果 SCT总的分期准确率为58.1%（18／31）。判断T分期的准确率为84.4%（27／32）,N分期的率为61.3%（19／31）。评价肿瘤浆膜外侵犯的繁感性和特异性分别为92.9%和50.0%。判断淋巴结转移的敏感性和特异性分别为70.0%和81.8%。结论 SCT扫描对结、直肠癌的术前分期有重要价值,有助于判断肿瘤浆膜外侵犯及区域淋巴结和远处转移情况。     

The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma

BACKGROUND: The purpose of the current study was to assess whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) provides incremental value (e.g., additional information on lymph node involvement or the presence of distant metastases) compared with computed tomography (CT) in patients with esophageal carcinoma. METHODS: The authors examined 149 consecutive patients with thoracic esophageal carcinoma. Eighty-one patients underwent radical esophagectomy without pretreatment, 17 received chemoradiotherapy followed by surgery, 3 underwent endoscopic mucosal resection, and the remaining 48 patients received definitive radiotherapy and chemotherapy. The diagnostic accuracy of FDG-PET and CT was evaluated at the time of diagnosis. RESULTS: The primary tumor was visualized using FDG-PET in 119 (80%) of 149 patients. Regarding lymph node metastases, FDG-PET had 32% sensitivity, 99% specificity, and 93% accuracy for individual lymph node group evaluation and 55% sensitivity, 90% specificity, and 72% accuracy for lymph node staging evaluation. PET exhibited incremental value over CT with regard to lymph node status in 14 of 98 patients who received surgery: 6 patients with negative CT findings were eventually shown to have lymph node metastases (i.e., they had positive PET findings and a positive reference standard [RS]); 6 patients with positive CT findings were shown not to have lymph node metastases (i.e., they had negative PET findings and a negative RS); and 2 patients were shown to have cervical lymph node metastases in addition to mediastinal or abdominal lymph node metastases. Among the remaining patients, PET showed incremental value over CT with regard to distant organ metastases in six patients. The overall incremental value of PET compared with CT with regard to staging accuracy was 14% (20 of 149 patients). CONCLUSIONS: FDG-PET provided incremental value over CT in the initial staging of esophageal carcinoma. At present, combined PET-CT may be the most effective method available for the preoperative staging of esophageal tumors.     

CT结肠造影对结直肠癌的诊断价值

目的:探讨CT结肠造影(CTC)技术在结直肠癌术前诊断与分期中的应用价值。方法:对临床怀疑结直肠癌的33例患者进行CTC检查,将影像学结果与病理结果进行比较,分析CTC的敏感性与特异性。结果:22例患者CTC诊断为结直肠癌,其中20例被病理证实,CTC对结直肠癌诊断的敏感性为100%(20/20),特异性为84.6%(11/13)。CTC对结直肠癌分型诊断符合率为90%(18/20),其中对肿块型诊断的敏感性为100%,特异性为100%;对浸润型诊断的敏感性为77.8%,特异性为100%;对溃疡型诊断的敏感性为100%,特异性为85.7%。CTC对结直肠癌分期诊断符合率为75%,对Duke'sA期病变诊断的敏感性为100%,特异性为94.1%;对B期病变诊断的敏感性为80%,特异性为73.3%;对C期病变诊断的敏感性为60%,特异性为100%;对D期病变诊断的敏感性为71.4%,特异性为100%。结论:CTC检查能够提供多方面的诊断信息,对结直肠癌的诊断及术前分期都很有价值。     

MSCT三期扫描在直肠癌术前TNM 分期诊断价值

目的:评价16层螺旋CT平扫及三期增强扫描对直肠癌术前诊断及TNM分期的诊断价值。方法:回顾性分析75例经病理证实的直肠癌,男性43例,女性32例,平均年龄57岁。所有患者术前采用16层螺旋CT平扫及三期增强扫描,所得数据行薄层及三维重组,对直肠肿瘤进行术前TNM分期,并与病理结果进行对照分析。结果:16层螺旋CT对直肠癌T 分期判定的准确率为83% ,对直肠癌N 分期判定的准确率为76% ,16层螺旋CT判断淋巴结转移的敏感性、特异性、阳性预测值及阴性预测值分别为62% 、87% 、73% 、80% 。16层螺旋CT判断肿瘤浆膜面浸润的敏感性、特异性、阳性预测值及阴性预测值分别为85% 、55% 、84% 、58%。结论:16层螺旋CT平扫及三期增强扫描对直肠癌的术前TNM分期与病理分期有较好的一致性,具有重要的临床价值。      

18FDG-PET对大肠癌分期、再分期诊断的价值

目的:评价18FDG-PET(18氟标记脱氧葡萄糖-正电子发射断层扫描)对大肠癌分期及术后再分期的价值。方法:对24例经肠镜检查初步诊断为直肠、结肠癌的患者行全身18FDG-PET检查,并在1～2W内完成手术及病理诊断。大肠癌术后18FDG-PET随访56例。结果:24例病理证实为大肠癌,23例局部18FDG摄取增高,SUVmax=7.09±3.26,2.98～12.2(SUV,Standarduptakevalue)。18FDG-PET对于肿瘤原发病灶诊断准确率为95%(23/24)。假阴性1例。单纯局部(主要为第1站)淋巴结转移8例(灵敏度8/16,50%),远处转移8例。改变33%(8/24)的患者治疗方案。56例随访病例中30例PET显示阴性,其中5例随访2年后复发,准确率83.4%。26例发现局部和/或多发转移,其中颈部淋巴结转移8例;肺及纵隔转移4例;肝转移7例;腹腔淋巴结转移11例;吻合口局部复发12例,骨转移11例。结论:18FDG-PET对大肠癌的分期和术后的再分期诊断有较高价值。     

Value of FDG PET/Contrast-Enhanced CT in Initial Staging of Colorectal Cancer - Comparison with Contrast-Enhanced CT

Background FDG PET/CT is at an equivocal stage to recommend for staging of colorectal cancer as compared to contrast-enhanced CT (ceCT). This study was intended to evaluate the value of FDG PET/ceCT in colorectal cancer staging as compared to ceCT alone. Materials and Methods PET/ceCT was performed for 61 colorectal cancer patients who were prospectively enrolled in the study. Three patients were excluded due to loss to follow-up. PET/ceCT ndings and ceCT results alone were read seperately. The treatment planning was then determined by tumor board consensus. The criteria for T staging were determined by the ndings of ceCT. Nodal positive by PET/ceCT imaging was determined by visual analysis of FDG uptake greater than regional background blood pool activity. The diagnostic accuracy of T and N staging was determined only in patients who received surgery without any neoadjuvant treatment. Results Of 58 patients, there were 40 with colon cancers including sigmoid cancers and 18 with rectal cancers. PET/ceCT in pre-operative staging detected bone metastasis and metastatic inguinal lymph nodes (M1a) that were undepicted on CT in 2 patients (3%), clearly de ned 19 equivocal lesions on ceCT in 18 patients (31%) and excluded 6 metastatic lesions diagnosed by ceCT in 6 patients (10%). These resulted in alteration of management plan in 15 out of the 58 cases (26%) i.e. changing from chemotherapy to surgery (4), changing extent of surgery (9) and avoidance of futile surgery (2). Forty four patients underwent surgery within 45 days after PET/CT. The diagnostic accuracy for N staging with PET/ceCT and ceCT alone was 66% and 48% with false positive rates of 24% (6/25) and 76% (19/25) and false negative rates of 47% (9/19) and 21% (4/19), respectively. All of the false negative lymph nodes from PET/ceCT were less than a centimeter in size and located in peri-lesional regions. The diagnostic accuracy for T staging was 82%. The sensitivity of the peri-lesional fat stranding sign in determining T3 stage was 94% and the speci city was 54%. Conclusions Our study suggested promising roles of PET/ceCT in initial staging of colorectal cancer with better diagnostic accuracy facilitating management planning.     

Diagnostic Value of CT Colonography in Colorectal Carcinoma

OBJECTIVE To investigate the value of CT colonography (CTC) in diagnosis and preoperative staging of colorectal carcinoma. METHODS CTC was performed on 33 patients who were suspected of having colorectal carcinoma. The results of CTC were compared with those of a pathological examination. RESULTS Among the 22 patients who were diagnosed with colorectal carcinoma by CTC, 20 cases were confirmed by pathology. The diagnostic sensitivity and specificity were 100% (20/20) and 84.6% (11/13) respec- tively. The accuracy of showing carcinoma pathologic patterns was 90% (18/20). The sensitivity and specificity were both 100% in the mass type; 77.8% and 100% in the infiltrating type; 100% and 85.7% in the ulcerated type. The accuracy of staging Dukes' carcinoma was 75%. The sensitiv- ity and specificity were 100% and 94.1% for Dukes'A; 80% and 73.3% for Dukes' B; 60% and 100% in Dukes' C; 71.4% and 100% for Dukes' D. CONCLUSION CTC produces a high success rate and provides con- siderable diagnostic information for both an accurate diagnosis of colorectal carcinoma and staging before operation.     

Imaging diagnosis in preoperative TNM staging of lung cancer

Conventional chest radiography (CR), computed tomography (CT) and magnetic resonance imaging (MRI) as staging modalities were compared in assessing the tumor extension and node status before operation in 57 patients with non-small cell bronchogenic carcinoma. The results showed that accuracy of 47 T1 and T2 lesions was 94%, 73% and 77% for CR, CT and MRI, respectively. CR and CT correctly evaluated 1 of the 2 T3 lesions and MRI was correct in both. CT and MRI correctly evaluated 4 of the 7 T4 lesions. MRI was superior to CT for left pulmonary artery invasion, but inferior to CT for pleural metastases. CR underestimated all of the 7 T4 lesions. The mediastinal lymph node metastases were evaluated preoperatively, giving sensitivities in CR, CT and MRI of 17%, 71% and 67%, respectively. The sensitivity of CT and MRI was higher than CR (P less than 0.01). The short axis of nodes greater than or equal to 10 mm was recommended for metastasis on the right side of mediastinum and the long axis greater than or equal to 10 mm for that in the other areas of mediastinum.     

摇篮体位技术在结肠癌术前CT分期的价值

为了评价摇篮体位技术结肠灌注CT扫描在结肠癌术前分期的价值,将130例结肠癌患者根据病变部位采取不同的摇篮体位,检查前低张肠道自肛门注入800～1 200mL的温水,增强CT扫描。右半结肠肿瘤取右侧卧位,左半结肠取左侧卧位。根据肿瘤的浸润程度和淋巴结情况进行CT分期,并与术后病理分期对照。术前CT分期T1低估3例,T2分别高估1例和低估4例,T3高估3例和低估3例,T4高估1例。T1分期准确率76.9%(10/13),T2准确率85.7%(30/35),T3准确率90.6%(58/64),T4准确率94.4%(17/18)。切除送检910个淋巴结中,CT检出581个,敏感性63.8%。送检淋巴结中确诊转移390个,CT诊断转移341例,特异性为87.4%。初步研究结果提示,摇篮体位技术结肠灌注CT扫描能够对结肠癌进行术前准确分期,为临床决策治疗提供有价值的信息。