结肠CT三维成像在直肠癌术前临床应用的研究

目的 探讨结肠3DCT成像在直肠癌术前临床应用的价值。资料与方法 对35例已知直肠癌患者先后进行结肠CT仿真内镜（CTVE）和结肠镜检查，并均经手术病理证实。采用16层螺旋CT进行全结肠扫描，在独立的工作站上进行结肠的三维重建，包括表面遮盖法（SSD）和CTVE。由2名影像学医师共同阅片。结肠外CT所见主要依据临床、手术及其他影像学检查所证实。结果 35例直肠癌共36个病灶（1例有2个癌灶），早期癌1个，进展期癌35个。进展期直肠癌中以Borrmann 2型最多见，占71．4％（25／35）；中分化癌20例，占57．1％；浸润全层者30例，占85．7％。3DCT对进展期直肠癌Borrmann分型判断的正确率达97．1％（34／35），而结肠镜的正确率为88．6％（31／35）。两种检查方法对于直肠癌的定位均比较满意。在3DCT中，SSD像最为直观立体，便于外科术前定位分析；CITE像最利于病灶大小的测量，与结肠镜的结果基本一致，与手术结果相符。25．7％（9／35）直肠癌患者的结肠镜检查时由于肠道严重狭窄或患者情况而失败，而这些患者在CTVE检查效果比较满意，在结肠远端发现2枚息肉和1个溃疡型癌，阳性所见占33．3％（3／9）。19例患者结肠CT检查发现结肠以外病灶，占54．3％（19／35），其中肝可疑性病灶占22．9％（8／35）。结论 结肠CT检查对于直肠癌患者的术前准确定位定性评价是有价值的，并且在补充结肠镜的不足、以及发现肠外病灶等方面也有重要临床意义。

Clinical Application of CT Three Dimension Imaging in Preoperational Evaluation of Rectum Cancer

Objective To discuss clinical application of CT three dimension imaging in preoperational evaluation of rectum cancer.Materials and Methods 35 patients with rectum cancer confirmed by pathology simultaneously were performed with CT virtual colonoscopy and colonoscopy, Using GE Lightspeed Ultra 16 slice CT to perform whole colon scan. Three dimensional images of colon were done at the workstation, including SSD images and CTVC images. Two imaging doctors together analyze CT images. Extracolonic CT diagnosis were validated by clinic, operation and the rest imaging examination.Results 35 patients with rectum cancer had 36 focus in all (1 case with two focus), 1 case with early stage and 35 cases with advanced stage. Borrmann 2 type rectum cancer was most common in advanced cancer, accounted for 71.4% (25/35); middle differentiation carcinoma 57.1% (20/35), infiltrating full slice most 85.7% (30/35). Preciseness ratio to estimate Borrmann type of advanced rectum cancer with three dimension CT was 97.1% (34/35), and that with colonoscopy was 88.6% (31/35). Two methods were relatively satisfied to orientation of rectum cancer. SSD images were most directly and stereoscopic and helpful to preoperational orientation; CTVC images were most favourable for measurement of focus size and consistent with colonoscopy and operation. 25.7% (9/35) patients with rectum cancer in Colonoscopy failure because of obvious stricture of colon or patient complex. But colon CT in these patients was satisfied and 2 polypus and 1 infiltrated ulcer carcinoma were found in distal colon, its positive results accounted for 33.3% (3/9). Extracolonic findings in 19 patients were found by colon CT and accounted for 54.3% (19/35). Liver lesions were accounted for 22.9% (8/35).Conclusion Colon CT examination is very valuable to qualitative diagnosis in patients with rectum cancer, it is also very important to complement colonoscopy shortage and find extracolonic findings.