低张结肠造影CT在结肠癌诊断中的应用

目的　探讨结肠癌的低张结肠造影CT诊断价值。方法　收集我院近 6年临床诊断肠梗阻、腹部肿块或 (和 )结肠灌肠X线造影疑为结肠癌的病例 5 5例 ,行低张结肠水 (或 3 %泛影葡胺 )灌注造影CT扫描 ,对手术病理证实的 3 5例CT片进行回顾分析。结果　 3 4例手术病理结果与CT诊断相符 ,其中 3 3例为结肠腺癌 ( 1例伴肠套叠 ) ,1例为腹腔多发转移性腺癌。 1例手术病理为“回盲部炎症、肉芽组织增生”误诊为结肠癌。 3 5例中 2 1例同时行结肠造影 ,15例诊断为结肠癌 ,1例造影正常 ,1例造影失败 ,4例为假阴性结果。结论　对临床情况允许的病例采用低张结肠水灌注CT扫描 (肠梗阻病人宜用 3 %泛影葡胺液灌注 ) ,能清晰显示病变原发灶 ,梗阻部位、范围 ,周围脏器等。优于常规CT和X线检查     

螺旋CT泛影葡胺灌肠对结肠癌的诊断价值

目的 :评价螺旋CT结合 2 %泛影葡胺灌肠对结肠癌的诊断价值。方法 :65例结肠癌患者用 2 %泛影葡胺灌肠后行CT扫描 ,并与术后病理对照分析。结果 :结肠癌病灶术前诊断准确率为 10 0 %,术前分期与手术符合率为 89.2 %。结论 :螺旋CT结合 2 %泛影葡胺灌肠对结肠癌的诊断有重要意义     

低张结肠水灌肠CT研究

传统检查结肠病变的方法主要有钡灌肠和结肠镜，外科多以这些检查结果为手术依据。笔者１９９３－０３～１９９６－１２用低张结肠水灌肠ＣＴ增强扫描显示结肠病变形态取得良好效果，认为该方法对结肠癌诊断、分期有一定价值。１材料和方法本组３５例，男２０例，女１５例...     

螺旋CT对结肠癌的诊断及术前分期价值

目的评价口服清水、2%泛影葡胺灌肠后螺旋CT扫描对结肠癌的诊断及术前分期价值。方法40例结肠癌患者检查前一日进流质饮食,检查当日晨常规清洁灌肠,口服清水、2%泛影葡胺灌肠后行CT扫描,结果与术后病理对照分析。结果直肠癌2例,乙状结肠癌7例,降结肠癌6例,横结肠癌5例,升结肠癌20例;根据Dukes’改良分期法,分为B期22例,C期12例,D期6例,与手术符合率为89.6%。结论螺旋CT扫描结合口服清水、2%泛影葡胺灌肠对结肠癌的诊断及术前分期有重要意义。     

多层螺旋CT结肠充气成像诊断结肠癌的影像与病理对照研究

目的:评价多层螺旋CT结肠充气成像对结肠癌分期的准确性。方法:对52例临床怀疑结肠癌的患者行结肠充气成像多层螺旋CT增强扫描并进行图像重建,观察肿瘤情况,作出诊断及分期并与病理对照。结果:低张结肠充气扩张显示良好,肿瘤显示清晰。多层螺旋CT检出全部47例结肠癌,敏感性100‰.依据Dukes分期标准,MSCT分期与手术病理对照,其符合率为:A期57.1‰,B期94.1‰,C期76.4‰,D期100‰,47例结肠癌中39例CT进行了正确分期,总体符合率为82.9‰。结论:多层螺旋CT结肠充气成像能够清晰显示结肠癌的形态、大小、周围组织侵犯及远处转移情况。CT分期与手术病理分期有高度的一致性。     

低张下灌水法螺旋CT对大肠癌的诊断价值

目的 探讨低张灌水螺旋CT扫描对大肠癌的诊断价值.方法 对68例经纤维结肠镜或手术病理证实的大肠癌患者的低张水灌肠螺旋CT扫描图像进行分析.结果 通过低张灌水法螺旋CT扫描检出了全部68例大肠癌,检出敏感度为100%,大肠癌Dukes改良法分期准确度为82.4%.结论 低张灌水螺旋CT检查可以有效地显示大肠癌的部位、大小和形态,能较准确地确定大肠癌的侵犯范围和转移,对大肠癌的术前诊断及肿瘤分期非常有价值.     

结肠癌的CT诊断

结肠癌是我国常见的消化道恶性肿瘤之一，其发病率仅次于胃癌和食道癌，其检查手段目前仍以结肠低张力气钡双重造影及内窥镜为首选。由于CT检查的普及，其作用逐渐得到认可；但至今对结肠癌的CT诊断报道较少，本文对我院25例经腔镜及手术病理证实的结肠癌CT资料进行回顾性分析，旨在探讨CT对其诊断价值。     

低张水灌肠MSCT检查在结肠癌诊断中的价值

目的:探讨16层螺旋CT在结肠癌诊断中的价值.方法:结肠癌36例采用低张水灌肠方法充盈结肠,全腹部三期MSCT扫描,并利用重建图像进行工作站下图像后处理,横断位图像结合最大密度投影(MIP)、多平面重建(MPR)、曲面重建(CPR),进行肿瘤TNM分期,术后与病理对照分析.结果:36例结肠癌MSCT T分期的敏感度为100%(36/36),阳性确诊率为88.57%(31/35),原发灶MSCT表现有肠壁不规则增厚,肠腔内肿块形成,肠腔狭窄;肠壁异常强化.合并肠套叠1例;合并肠梗阻1例.邻近脏器直接侵犯4例,淋巴结转移11例,远处转移5例.结论:16层螺旋CT低张水灌肠成像技术对结肠癌检出率有很高价值,同时能显示肠壁外、近脏器侵犯以及远处转移情况.可作为结肠癌术前肿瘤分期的首选检查方法.     

影像学检查对结肠癌诊断价值的临床研究

目的　探讨对结肠癌诊断的影像学检查程序。方法　对经手术病理证实的 82例结肠癌的结肠气钡双重造影、纤维内镜、常规腹部B型超声和CT检查进行对比研究。结果　结肠气钡双重造影、纤维内镜、B型超声、CT扫描的病灶检出率分别为90 .1%、89.5 %、5 3 .8%和 5 3 .3 % ,前两者与后两者之间差异显著 (Ρ <0 .0 5 )。肝脏转移瘤诊断符合率B型超声、CT扫描为 10 0 %。结论　结肠气钡双重造影和结肠内镜是结肠癌筛选的重要方法 ,B型超声、CT扫描所见是结肠癌术前分期的可靠依据     

MSCT扫描在进展期胃癌术前评估及分期中的应用价值

目的:评价低张力口服水多层螺旋CT(MSCT)3期扫描对进展期胃癌的诊断、分期及可切除性判断的价值.方法:65例患者口服水,在低张状态下进行动态增强扫描.判断肿瘤诊断及分期,预测手术可切除性,并与手术及病理相对照.结果:本组病例52例行手术治疗,13例MSCT评估为Ⅲ、Ⅳ期放弃手术而行介入和化疗.CT表现为胃壁增厚、软组织肿块、胃壁多层结构破坏.淋巴结及邻近、远处脏器的侵犯及转移分别为40.1%、16.9%和20%.CT分期与手术病理分期相符者43例,胃癌cT分期总的准确率82.7%.结论:MSCT在进展期胃癌诊断、分期及可切除性判断等方面具较高的价值,能够为临床诊治提供有益的指导.     

多层螺旋CT成像技术在结肠肿瘤诊治中的应用

目的　提高多层螺旋CT对结肠肿瘤诊治中的认识。方法　通过对30例结肠肿瘤病人的MSCT轴位图像和重建的4-D、MIP及仿真内窥镜图像进行观察分析,分别对各病例进行诊断及术前评估,并与其相应的钡灌肠及纤维结肠镜结果进行对照性研究。结果　所有病人的诊断符合率为100%,明显优于其它检查方法,其仿真内窥镜结果与纤维结肠镜结果吻合。结论　多层螺旋CT在结肠肿瘤的诊治中,具有独特的优越性。     

Endoluminal CT colonography after an incomplete endoscopic colonoscopy

OBJECTIVE: We evaluated the clinical usefulness of endoluminal CT colonography after an incomplete colonoscopy. SUBJECTS AND METHODS: We prospectively studied 40 patients in whom the cecum could not be reached endoscopically despite adequate bowel preparation. Endoluminal CT colonography (120 kVp, 120 mA, 3-mm collimation, pitch of 2, 1.5-mm interval reconstruction) was performed within 2 hr of incomplete colonoscopy. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal images were analyzed. Twenty-six patients (65%) underwent barium enema immediately after endoluminal CT colonography. We analyzed colonic distention; duration of endoluminal CT colonography; patient tolerance; number of colonic segments seen at colonoscopy, endoluminal CT colonography, and barium enema; and reasons for incomplete colonoscopy as well as colonic and extracolonic findings. RESULTS: Duration of endoluminal CT colonography was 14.2 +/- 4.6 min (mean +/- SD). Endoluminal CT colonography was better tolerated than colonoscopy or barium enema (p < .001). Probable causes for incomplete colonoscopy were identified at endoluminal CT colonography in 74% of 40 patients. Baseline colonic distention in the region of the transverse and right colon was considered adequate before additional air insufflation; however, the addition of air significantly enhanced colonic distention throughout the entire colon (p < .001). Endoluminal CT colonography adequately revealed 96% of all colonic segments; in comparison, barium enema adequately revealed 91% of all segments (p < .05). CONCLUSION: In patients with incomplete colonoscopy, endoluminal CT colonography successfully showed the previously unrevealed colon in more than 90% of patients. Endoluminal CT colonography is a rapid, well-tolerated technique that provides clinically useful colonic and extracolonic information and should be considered for all patients who undergo incomplete colonoscopy.     

Contrast enema before bypass surgery for small-bowel obstruction in the oncologic patient: is it necessary?

OBJECTIVE: We performed a retrospective study to determine the usefulness of contrast enema examinations in patients with small-bowel obstruction and known intraabdominal malignancy. MATERIALS AND METHODS: Thirty-two patients with known or suspected intraabdominal malignancy and small-bowel obstruction who underwent both CT and subsequent contrast enema were identified. CT and contrast enema reports were reviewed for patients with tumor involvement of the colon to determine whether the contrast enema findings had provided additional information to the data that had been acquired with CT. In cases in which the contrast enema had provided additional information, the patients' medical records were reviewed to determine whether treatment had been modified as a result of the additional information. RESULTS: In 14 (44%) of 32 patients, the contrast enema provided evidence of synchronous colonic disease not previously detected. The colonic involvement could be classified into two categories: implants (n = 1) and narrowing or complete obstruction (n = 13). Findings of the contrast enema resulted in a change in treatment in 10 (32%) of 32 of our patient population. CONCLUSION: Patients with known intraabdominal malignancy who present with small-bowel obstruction may have synchronous large-bowel disease that is undetectable on standard CT scans. In these patients, the additional information provided by the contrast enema altered subsequent treatment.     

Carcinoma of the colon: detection and preoperative staging by CT

This report analyzes the detection rate and role of CT in the preoperative evaluation of 90 consecutive, proved cases of colon carcinoma. In this study, the overall detection rate was 84%; however, the rate varied from 68% in unprepared colons to 95% in clean colons that were adequately distended with air. Sensitivity of detection depends mainly on the size of the lesion and the quality of the examination. CT was less sensitive than barium enema in detection, but it had a similar specificity in differentiating neoplastic lesions from inflammatory lesions. On the basis of our criteria of staging, CT evaluation resulted in a sensitivity of 55% for local invasion, 73% for regional nodes, and 79% for liver metastases. Compared with Dukes classification, CT correctly staged 64% of all patients but showed significant variations in staging different groups with lower results in the Dukes A, B, and C patients. CT, however, showed a sensitivity of 81% and a positive predictive value of 100% in detecting Dukes D lesions. In general, although negative CT findings do not help in staging a colonic tumor, positive findings are highly indicative of neoplastic spread. We believe that this feature justifies the use of CT in the preoperative evaluation of colonic tumors.     

MSCT低张水灌肠技术在大肠癌诊断中的应用价值

目的：探讨MSCT低张水灌肠技术在大肠癌诊断中的应用价值。方法：选取临床和／或纤维结肠镜检查拟诊大肠癌患者70例作为研究对象（排除严重肠梗阻患者）。所有患者均行MSCT低张＋水灌肠＋体位扫描＋三期动态增强扫描。由2名高年资放射科医师阅片,重点观察病变部位、大小、形态、肠壁厚度及分层情况,病变强化特征,浆膜面改变,肠周脂肪间隙,邻近血管,淋巴结及远处脏器。防止遗漏小病灶。以术后病理TNM分期为金标准,采用诊断性试验,判断MSCT对大肠癌分期的敏感性、特异性及准确度。结果：70例大肠癌MSCT全部检出,病变位于升结肠13例,横结肠2例,降结肠3例,乙状结肠21例,直肠31例。本组61例低张水灌肠效果满意,较好显示病变部位、形态、长度及肠壁侵犯深度,9例肠管未充分扩张,肿瘤境界显示不满意,其中升结肠3例．肝曲结肠1例,直肠下段5例。病变处肠壁不规则增厚,部分肿块形成,最大约12．5cm×10．3cm。病变最长约15．0cm。病变不同程度强化．明显强化者占82．86％（58／70）,强化幅度平均为（43．5±15．7）HU。大肠癌TNM分期准确度为87．14％（61／70）．其中T分期准确度为88．57％（62／70）。N分期准确度为87．14％（61／70）,M分期准确度为90％（63／70）。结论：MSCT低张水灌肠技术能较清楚的显示病灶部位、大小、形态、长度、肠壁浸润深度。对大肠癌术前分期准确度较明显提高。但对于升结肠近端及直肠下段肿瘤病变显示有一定限度。     

大肠癌的螺旋CT三维重建研究及外科应用评价

目的 :探讨螺旋CT三维重建技术在大肠癌外科术前诊断中的价值。材料和方法 :选 2 0例有低张气钡灌肠造影及病理证实的大肠癌 ,行低张充气螺旋CT扫描 ,表面覆盖显示 (SSD)、容积漫游技术 (VRT)、多平面重组 (MPR)等三维重建 ;另 10例行常规及低张注生理盐水CT检查。本法与造影、常规CT、低张注水CT及手术、病理对照观察。结果 :常规CT检出率为 4/ 10 ;低张注水CT检出率为 7/ 10 ;低张气钡灌肠造影检出率为 2 0 / 2 0 ;螺旋CT三维重建检出率为 2 0 / 2 0。前三者在检出率或观察内容上均有各自限度 ,后者可弥补。结论 :SSD、VRT可显示 6mm隆起病变和 3mm管腔狭窄 ,VRT可显示 1mm细沟凹陷 ;MPR对轻微的肠壁增厚、僵硬很敏感 ,能准确判断病灶外侵程度 ;SSD酷似内窥镜 ,VRT可比低张气钡灌肠造影 ,SCT三维重建可一法多用。     

Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma

OBJECTIVE: The purpose of this study was to assess the value of characteristic thin-section helical CT findings of acute diverticulitis involving the cecum and ascending colon in excluding colonic carcinoma. MATERIALS AND METHODS: Thin-section helical CT scans (5-mm collimation) of 19 consecutive patients with proven diverticulitis and 21 consecutive patients with surgically proven carcinoma involving the cecum and ascending colon were reviewed retrospectively. Two radiologists independently analyzed these parameters: degree of pericolic infiltration, mesenteric fluid, vascular engorgement, arrowhead-shaped wall thickening, air-filled diverticula, inflamed diverticula, and preserved enhancement pattern of involved colonic wall. Inter-observer agreement was assessed with a kappa statistical analysis, and the features that most distinguished diverticulitis from colonic carcinoma were selected with a stepwise logistic-regression analysis. RESULTS: The two CT findings of right-sided colonic diverticulitis that most distinguished it from colonic carcinoma were inflamed diverticula and the preservation of an enhancement pattern of the involved colonic wall. Excellent interobserver agreement (kappa > 0.60) was obtained for both findings. Inflamed diverticula (kappa = 0.80) had a mean sensitivity, specificity, and accuracy for diverticulitis of 86.8%, 92.9%, and 90.0%, respectively, in differentiating right-sided colonic diverticulitis from colonic carcinoma. Preserved wall enhancement pattern (kappa = 0.70) had a mean sensitivity, specificity, and accuracy of 89.5%, 95.3%, and 92.5%, respectively. CONCLUSION: On thin-section helical CT, an inflamed diverticula and a preserved enhancement pattern of the thickened colonic wall were the two most statistically significant CT findings of acute diverticulitis involving the cecum and ascending colon that distinguished diverticulitis from colonic carcinoma.