结肠癌肝转移的螺旋CT特征及临床价值

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100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100ml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156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54．2％。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.

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

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.