直肠癌的CT表现及其对术前分期的意义

目的分析直肠癌的CT特征,并评价其诊断意义。方法回顾性分析经手术、病理证实的18例直肠癌病例的临床与CT资料,并依据CT表现对18例直肠癌病变进行了术前CT分期。结果直肠癌的CT表现主要为肠壁增厚,肠腔内肿块,肠腔狭窄,肠周浸润,淋巴结转移。术前CT正确分期15例（83.3%）。结论直肠癌术前CT检查对病变的严重程度的判断,设计合理的治疗和手术计划以及预后的估计具有很高的临床应用价值。     

直肠癌CT分型（附28例病理对照）

本文对２８例直肠患者术前ＣＴ扫描，根据ＣＴ影像将直肠癌分成四种类型：即息肉型、局限浸润型、广泛浸润型和团块型。同时进行ＣＴ分期，对照手术病理分期，探讨ＣＴ分型和分期之间的关系以及价值。另外还讨论直肠ＣＴ扫描的意义及限度。     

16层螺旋CT及TopoⅡ表达分析在直肠癌术前分期中的价值

目的：探讨螺旋CT扫描及回旋酶（topoⅡ）表达相结合在直肠癌术前分期诊断中的意义。方法：应用螺旋CT增强扫描对111例直肠癌进行术前分期;对111例直肠切除标本组织进行topoⅡ表达分析,与手术及术后病理对照;探讨二者在直肠癌术前分期中的价值。结果：螺旋CT扫描对直肠癌T分期准确度为79.3%,N分期准确度86.5%,M分期准确度90.9%,综合判断CT对直肠癌TNM分期总准确度为89.2%。直肠癌组织中topoⅡ表达阳性率85.6%。直肠癌病理分期为Ⅱ、Ⅲ、Ⅳ期者其癌组织的topoⅡ表达阳性率明显高于Ⅰ期;伴有淋巴结转移者直肠癌组织的topoⅡ表达阳性率明显高于淋巴结转移阴性者。结论：16层螺旋CT扫描及topoⅡ检测都有利于直肠癌术前分期的判断,topoⅡ检测弥补了CT对于N分期判断准确度低的缺点,两者结合有利于提高分期诊断的准确率。     

螺旋CT在直肠癌诊断及其术前分期中的价值

目的：探讨直肠癌的CT表现及其术前分期价值。方法：对33例经内镜或手术活检病理证实为直肠癌的患者进行CT回顾性阅片，分析其CT征象并进行术前分期．并将CT表现与病理结果进行对照。结果：直肠癌CT表现为肠壁增厚、肠腔狭窄、软组织肿块及周围组织结构侵犯、区域淋巴结肿大和远处转移。直肠癌术前CT分期诊断和病理分期的总符合率为92％。结论：直肠癌的CT征象具有一定的特征性，CT在直肠癌术前分期中具有较高的准确性，对治疗方案的确定具有重要参考价值。     

Preoperative staging of rectal carcinoma by transrectal echography combined with pelvic computerized tomography

The accurate staging of rectal carcinoma is very important for treatment planning. The histological data obtained from the surgical specimens of 22 patients with rectal carcinoma were compared with pre- and postoperative endorectal US findings and with preoperative CT results. According to an adapted version of the Astler and Coller classification, the different degrees of tumor spread into the rectal wall were represented as follows: stage A: 1 patient; stage B1: 5 patients; stage B2: 6 patients; stage C1: 1 patient; stage C2: 8 patients and stage D: 1 patient. Preoperative staging, based on the overall results of CT and US, was in agreement with histology in 19 of 22 cases. Individual analysis of US and CT results, in comparison with histological data, showed US staging accuracy to be 77.3% (17/22 patients). US accuracy in demonstrating tumor spread into the rectal wall (stages A, B1, C1) was 100% (7/7 patients); US was 70% accurate in lymph node detection (7/10 patients) and 93.3% accurate in demonstrating perirectal infiltration (14/15 patients). CT diagnostic accuracy was 66.7% (10/15 patients) in the evaluation of perirectal lymph nodes, but tumor spread into the rectal wall (stages A and B1) could not be evaluated. While admitting the primary role of US in the staging of rectal carcinoma, according to our results a combination of US and CT yields a more accurate preoperative diagnostic picture.     

直肠癌的CT检查价值

目的　探讨CT对直肠癌的诊断价值。方法　对 2 6例经活检或手术病理证实为直肠癌的患者行CT回顾性分析。结果　CT术前分期准确率D期为 85 .7% ,B -2期为 2 0 % ,术后局部复发准确率为 6 0 % ,远处转移准确率为 75 %。结论　CT术前主要适用于晚期病人的分期 ,以便采取合适的治疗方案 ,避免不必要的手术 ;术后对监测局部复发和远处转移起重要作用。     

直肠癌CT诊断的价值分析

目的:通过直肠癌CT表现,分析其诊断及检查的价值。方法:回顾性分析经手术及肠镜病理证实的115例直肠癌病人的CT征象。结果:直肠癌多表现为肠壁局限性增厚、不规则的软组织肿块,肠腔变形、狭窄,邻近组织受侵则界限不清;CT检查的敏感性为93%,术后局部复发的准确率为80%。结论:CT检查能为直肠癌中晚期病人术前分期提供重要依据,对临床制定恰当的治疗方案价值较大,且为术后监测的重要手段,它的最大价值是显示直肠癌在腔内外生长的形态大小、侵犯范围及转移。     

直肠癌的CT检查及价值：附28例病理对照

目的：探讨直肠癌术前ＣＴ检查的意义及价值。材料和方法：回顾分析２８例直肠癌患者术前ＣＴ所见和手术病理结果对照，以及术前Ｔｈｏｅｎｉ氏ＣＴ分期和改良Ｄｕｋｅｓ病理分期对照。结果：术前ＣＴ能显示直肠癌的形态、大小、范围和肠壁的厚度。确定直肠周围组织浸润准确率为８２．１％，敏感性９０．９％，特异性７６．５％，确定肠旁淋巴结转移准确率６４．３％，敏感性５０％，特异性９０％；ＣＴ分期准确率为８５．７％。结论：直肠癌术前ＣＴ检查及ＣＴ分期能客观反映直肠癌的病理改变，同时行上腹部甚至全腹部扫描，可明确有无肝脏等远处脏器转移，对直肠癌患者治疗方法的选择有重要意义，提高患者的５年生存率亦有一定价值。     

The role of CT in the staging and radiotherapy planning of prostatic tumours

Fifty patients with proven carcinoma of the prostate have been evaluated with CT. The CT studies were carried out for staging and radiotherapy planning and the findings compared with rectal examination and lymphography. CT provided useful additional information to that obtained by rectal examination in 40% of patients and these findings had important implications for radiotherapy planning. There was good correlation between CT and lymphography in the assessment of pelvic lymph node involvement.     

Rectal carcinoma: CT staging with water as contrast medium

Computed tomography (CT) was used to study 42 patients with rectal carcinoma. Water was used as a contrast medium for studying the local extent of tumor in all patients. Scans were read prospectively without knowledge of the histologic staging and then compared with pathologic specimens. CT depicted the tumor in all patients. Comparison of CT and histologic results (following the Dukes classification) showed that disease was correctly staged as A in three of four patients, as B in eight of 12, as C in 15 of 17, and as D in nine of nine. Overall, carcinoma was correctly staged with CT in 35 of 42 patients (diagnostic accuracy, 83.3%). The accuracy in the assessment of local invasion was 97.6% (41 of 42). In the detection of lymph node involvement, the accuracy was 78.6% (sensitivity, 88%; specificity, 64.7%). CT is recommended in the preoperative staging of rectal carcinoma and as an aid in choosing the appropriate therapy. The use of water enema and complete distention of the rectum are reliable techniques for improving the accuracy of CT in the assessment of local invasion by cancer.     

Preoperative and postoperative CT staging of rectosigmoid carcinoma

This study reports a 4 year experience using CT for preoperative staging and for evaluation of patients with rectal and sigmoid carcinoma after surgery. All patients were evaluated on a GE 8800 scanner using 1 cm contiguous slices. Only 15 of the 25 preoperative patients were staged correctly. The other 10 patients were understaged by CT. The accuracy of detecting local invasion was 70%, but only seven (35%) of 20 patients had accurate assessment of lymph nodes. The overall accuracy of CT staging in the 46 postoperative patients was 87%, with a sensitivity of 91% and a specificity of 72%. Most recurrences were found in the pelvis; 16 patients had liver metastases, and metastatic disease obstructing the ureters was detected in eight patients. On the basis of these results, it was concluded that CT should not be used routinely to preoperatively stage patients with rectosigmoid carcinoma. However, all patients who have undergone resection for rectal or sigmoid carcinoma should have aggressive CT evaluation including a baseline study at 2-4 months and then follow-up studies at every 6 months for at least 2 years. All new or enlarging masses should have CT-guided biopsies. This approach may prolong survival by detecting early asymptomatic recurrences.     

直肠癌CT诊断与分期

目的:评价CT在诊断和直肠癌分期的价值。材料和方法:回顾性分析150例经手术病理证实的直肠癌的CT表现,评价其CT诊断和分期的价值。结果:直肠癌CT的主要表现包括肠壁增厚50例、软组织肿块61例和肠腔狭窄49例;与手术病理对照,CT显示病灶、周围组织侵犯和淋巴结转移的准确性分别为96.7%(145/150)、88.4%(84/95)和51.7%(15/29);CT分期与Dukes分期的总符合率为83.3%。结论:直肠癌的CT诊断和分期与手术病理分期有很好的一致性,CT是直肠癌术前诊断的重要影像检查方法。     

Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience

PURPOSE: The aim of this study was to measure the sensitivity and clinical indications of Magnetic Resonance (MR) as compared to Transrectal Ultrasonography (TRUS) and spiral Computed Tomography (CT) in the preoperative staging and evaluation of rectal carcinoma. MATERIALS AND METHODS: Twenty patients with histologically proven rectal carcinoma were examined with phased-array coil MRI. We used T1 and T2, spin-echo, turbo-spin-echo, flash2D sequences with and without fat suppression; FOV 180-280; 4-6 mm slice thickness; i.v. Gadolinium. The MR images were compared with TRUS, spiral CT and with the final histological diagnosis. RESULTS: MR showed a 92.3% sensitivity for rectal wall infiltration vs. 100% of TRUS and 75% of CT. The sensitivity for lymph node metastases was 76.4% vs. 72.2% for TRUS and 88% for CT. CONCLUSIONS: Locoregional staging of rectal cancer by MRI shows a high sensitivity and is also feasible in stenosing or proximal rectal lesions. TRUS, despite its limitations, is still the most sensitive method for the evaluation of wall infiltration. CT was less sensitive than the other two METHODS: The sensitivity of MR and CT for lymph node metastases is comparable, but the former is more specific.     

PET/CT在指导直肠癌术后放疗中的意义

 目的回顾性探讨PET/CT在检测直肠癌术后患者的分期,分析PET/CT对直肠癌术后骶前软组织肿块的诊断准确率,以及对放射治疗的指导作用.方法选择手术后直肠癌29例,在行放射治疗前行PET/CT检查,其结果分别与同期的CT结果相比较.结果29例中发现7例11处高代谢灶,骶骨前间隙3例,髂骨+腰椎1例,盆腔淋巴结+肝脏2例,腹膜后淋巴结+锁骨上淋巴结1例.结论PET/CT能够更准确地反映手术后直肠癌患者的病变范围,能够指导治疗方案的选择.     

直肠癌术前CT扫描的价值

目的：评估直肠癌术前ＣＴ扫描的价值。材料与方法：１０４例直肠癌（Ｔ２期１１例、Ｔ３期９０例、Ｔ４期３例）的ＣＴ扫描与手术病理这缘改变、浸润周径、淋巴结大小对Ｔ、Ｎ分期的价值。结果：以肿瘤石头居齿状和结节改变作为Ｔ３的诊断指标,其准确率分别为９４．０％、９０．４％、８８．４％;Ｔ分期的准确率是８９．４％,Ｔ３的准确率是９４．０％。将肿瘤侵犯肠管周径〉１／２与≤１／２作为Ｔ３期的诊断指标,有显著统计学     

Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology

AIM: Although magnetic resonance (MR) imaging is widely used for rectal cancer staging, many centres in the UK perform computed tomography (CT) for staging rectal cancer at present. Furthermore in a small proportion of cases contraindications to MR imaging may lead to staging using CT. The purpose of this study was to evaluate the accuracy of current generation multidetector row CT (MDCT) in local staging of rectal cancer. In particular the accuracy of multiplanar (MPR) versus axial images in the staging of rectal cancer was assessed. MATERIAL AND METHODS: Sixty-nine consecutive patients were identified who had undergone staging of rectal cancer on CT. The imaging data were reviewed as axial images and then as MPR images (coronal and sagittal) perpendicular and parallel to the tumour axis. CT staging on axial and MPR images was then compared to histopathological staging. RESULTS: MPR images detected more T4 and T3 stage tumours than axial images alone. The overall accuracy of T-staging on MPR images was 87.1% versus 73.0% for axial images alone. The overall accuracy of N staging on MPR versus axial images was 84.8% versus 70.7%. There was a statistically significant difference in the staging of T3 tumours between MPR and axial images (p<0.001). CONCLUSION: Multidetector row CT has high accuracy for local staging of rectal cancer. Addition of MPR images to standard axial images provides higher accuracy rates for T and N staging of rectal cancer than axial images alone.     

Comparative study of suprapubic sonography and computed tomography for staging of prostatic carcinoma

In addition to the digital rectal examination, suprapubic transvesical ultrasonography and computed tomography were used to stage local tumor extension in 41 patients with histologically proven prostatic carcinoma. Although 22% of the cases revealed stage A/B disease on rectal examination, these numbers were 7% for ultrasonography and 37% for CT. For stage C/D disease the percentages were 73% for digital rectal staging, 81% for sonography, and 30% for CT. Compared with the digital examination, 22% versus 10% of the cases had to be upstaged by the results of ultrasound versus CT. A downstaging became necessary by sonography in 7% and by CT in 44%. The results are compared with the findings after prostatectomy, autopsy, and cystoscopy as well as with pathohistological data from the literature. From these results, suprapubic transvesical sonography is considered to be more reliable than CT for local tumor staging.     

Computed tomography and endosonography in the preoperative staging of rectal carcinoma

In 30 patients with rectal carcinoma the accuracy of computed tomography (CT) and endosonography (ES) was compared with the surgical specimen. Three cases were overstaged by ES and 4 cases were understaged by CT. The accuracy of ES was 84% and of CT only 76%. Both methods had advantages and limitations. An accurate staging of lymph node metastases was possible neither by ES nor by CT. - We advocate endosonography as the first imaging examination after proctoscopy. CT is recommended in endosonographic doubtful findings and in tight stenoses.     

直肠癌影像学

直肠癌作为消化道常见恶性肿瘤之一,其发病率呈上升趋势,影像学检查技术发展迅速,在直肠癌的诊断和分期中起着重要作用,本文比较全面地介绍了新的影像学技术如直肠内超声,CT,MRI和PET在直肠癌诊断和分期中的价值,对直肠癌的发病情况,临床特征,病理及其临床分期也作了论述。     

肾盂癌19例CT诊断临床分析

目的探讨CT检查对肾盂癌的诊断价值。方法回顾性分析经CT检查及手术病理证实的19例肾盂癌患者的CT表现和临床资料。结果根据CT表现分为肾盂内肿块型10例,肿块浸润型6例,肾盂壁厚型3例;CT分期为Ⅰ～Ⅱ期8例,Ⅲ期7例,Ⅳ期4例。结论 CT检查在肾盂癌的诊断及鉴别诊断中有一定的价值,是诊断肾盂癌的主要检查方法。