多层螺旋CT在胃肠道肿瘤诊断中的价值

目的 探讨多层螺旋CT(MSCT)检查在胃肠道肿瘤术前定位与分期诊断中的临床价值.方法 (1)对胃镜活组织检查确诊为胃癌的332例患者进行术前MSCT检查,比较CT分期结果与术后病理检查结果.(2)对73例小肠肿瘤患者进行术前CT检查,比较小肠淋巴瘤和小肠癌在CT成像上的区别.(3)对228例经纤维结肠镜活组织检查确诊为结直肠癌患者进行术前MSCT检查,采用x.检验分析结直肠癌的CT征象特点.结果 (1)MSCT能提供定位或重建胃周血管等更多信息,对胃壁浸润深度、淋巴结转移、远处转移的总体诊断准确率分别为78.2%(244/312)、67.3%(210/312)和93.8%(30/32).(2)MSCT检查小肠癌主要表现为包块和肠壁浸润性增厚,且肠壁增厚一般不出现分层,肠梗阻多见,但肠系膜淋巴结和后腹膜淋巴结肿大检出率低.小肠淋巴瘤的CT检查表现与小肠癌相反.(3)表面毛糙征与不均匀强化等CT征象对诊断结直肠癌有重要意义,增强后CT值测定有助于鉴别结肠炎性病变.结论 MSCT可在胃肠道肿瘤术前定位与分期诊断中提供准确的影像学信息,结合内镜检查更能提高诊断准确率.     

多层螺旋CT血管造影在胃癌规范性根治术术前评估中的价值

目的 探讨多层螺旋CT血管造影(multislice spiral computed tomography angiography,MSCTA)在胃癌规范性根治术术前评估中的价值.方法 通过术前MSCTA了解86例胃癌患者腹腔干三大动脉分支及其属支(肝总动脉、肝右动脉、肝左动脉、脾动脉、胃左动脉)的解剖走行情况,并经术中验证;同时采用MSCTA对胃癌进行术前TNM分期,并将其与手术后病理结果 进行对照.结果 通过术中探查验证,86例患者术前MSCTA评估腹腔干三大动脉分支及其属支走行情况的准确率为100%.肝动脉解剖异常者22例,变异率为25.58%,其中异常肝右动脉11例(12.79%)、异常肝左动脉7例(8.14%)、同时存在异常肝左及异常肝右动脉1例(1.16%)、肝总动脉源自肠系膜上动脉3例(3.49%).脾动脉直型24例(27.91%),轻曲型44例(51.16%),显著曲型18例(20.93%).本组未发现胃左动脉变异情况.通过与术后病理对照,MSCTA对胃癌术前T、N、M分期的准确率分别为75.58%(65/86)、74.42%(64/86)和91.86%(79/86).结论 MSCTA能较客观地评估胃癌患者术前腹腔于三大动脉分支及其属支的解剖走行情况及较为准确地进行胃癌术前TNM分期,在制定手术方案、防止术中动脉损伤等方面有着重要的作用.     

多层螺旋CT在骨关节疾病诊断中的应用价值

目的探讨多层螺旋CT二维和三维重建技术在骨关节疾病诊断中的应用价值。方法对57例骨关节疾病患者进行多层螺旋CT扫描，并进行二维多平面重建（MPR）和容积再现重建（VRT），分析病变的情况。结果MPR对骨关节疾病细节显示满意，可以多平面观察骨的密度、形态、大小变化及发现邻近软组织改变；而Ⅵ汀三维重建对病变的定位和空间关系理解更直观、立体、准确，简化了思维。结论多层螺旋CT对骨关节疾病诊断具有很高的应用价值。作为轴位图像的重要补充，2D-MPR和3D-VRT重建能更直观和立体地显示病变，两者结合使用，对临床治疗方案和手术方案的制订具有重大的指导意义。     

多层螺旋CT联合CRP术前评估结肠癌分期的临床研究

目的：探讨64排多层螺旋CT（MSCT）联合炎症因子血清C反应蛋白（CRP）术前评估结肠癌的临床价值和对手术方案选择的影响。方法：将2011年1月—2011年12月于我院胃肠外科住院的96例结肠癌患者随机均分为A组和B组,A组术前行MSCT和CRP联合评估,B组只进行MSCT评估,对术前分期和预测手术方案与术后病理分期和实际手术方案进行比较。结果：本研究实际纳入病例90例,A组45例,B组45例,两组基线情况一致。A组术前T、N、M及TNM分期的准确度分别为71.1%、86.7%、97.8%及84.4%;B组术前T、N、M及TNM分期的准确度分别为66.7%、66.7%、95.5%及66.7%。A组和B组在N、TNM分期的差异有统计学意义（P=0.013、P=0.023）。A组手术符合率为97.8%（44/45）,B组手术符合率为86.7%（39/45）,两组间预测符合率差异具有统计学意义（P=0.037）。结论：MSCT联合CRP评估结肠癌患者的策略可以提高术前分期的准确性和手术预测方案的符合率。     

多层螺旋CT在肾盂癌诊断中的价值

目的:探讨多层螺旋CT在肾孟癌的诊断和鉴别诊断中的应用价值.方法:经手术病理证实的20例患者,其中移行细胞癌16例,鳞状上皮癌4例,术前均行多层螺旋CT平扫和增强扫描,由两名主治医师以上职称共同阅片,将扫描图像进行平扫、动脉期、静脉期和分泌期及延迟期多期分析,与病理对照.结果:肾孟内肿决型15例,浸润肾实质型4例,肾孟壁增厚型1例.增强扫描动脉期18例肿瘤轻度不均匀强化,静脉期和分泌期11例病灶强化程度几乎没有改变,与相邻肾实质相比肿瘤呈低密度,15例延迟增强扫描见肾孟内充盈缺损.其中2例出现尿漏.1例肾孟内见型略高密度影,术前诊断凝血块,术后病理为乳头状移行细胞癌.结论:多屡螺旋CT平扫加增强扫描可提高肾孟癌的诊断正确率,平扫有利于和结石的鉴别,多平面重建更清晰显示病变位置及形态,增强扫描更有利于病变的定性诊断.     

多排螺旋CT检查在结肠癌诊断中的临床价值

为探讨多排螺旋CT（MSCT）及后处理技术在结肠癌诊断的应用价值,2013年6月至2014年6月南京医科大学附属无锡二院收集经手术病理学检查证实的57例结肠癌患者资料进行分析.患者行MSCT平扫及增强检查,图像行多平面重组（MPR）、滑动薄层最大密度投影（STS-MIP）、曲面重组（CPR）后处理,并与术后病理TNM分期比较.57例患者中,肿瘤位于盲肠1例,升结肠23例,结肠肝曲9例,横结肠11例,结肠脾曲1例,降结肠3例,乙状结肠9例.MSCT检查与术中探查结果一致.57例患者肠壁均不规则环状增厚,增厚范围为0.6 ～3.2 cm,存在不同程度的肠腔狭窄;16例患者出现液气平,伴有肠腔扩张,表现为肠梗阻征象.42例患者有软组织结节或包块影,表现为软组织结节或包块向肠腔内和（或）肠腔外生长,导致肠腔不同程度狭窄.包块与周围肠壁分界可以清楚或者边界模糊,周围肠壁厚度正常.20例患者形成癌性溃疡.溃疡表现为火山口状.47例患者出现浆膜层和（或）周围脏器受侵犯.27例患者发生淋巴结转移.6例患者发生远处转移,其中4例肝转移,2例肺转移.术前MSCT检查T分期的灵敏度为100.0％ （57/57）,准确度为77.2％ （44/57）;术前MSCT检查N分期灵敏度为67.9％ （19/28）,特异度为72.4％ （21/29）,准确度为70.2％ （40/57）;术前MSCT检查M分期灵敏度为100.0％ （6/6）,特异度为100.0％ （51/51）,准确度100.0％（57/57）,术前MSCT检查TNM分期结果与术后病理学检查分期一致性较好（κ =0.592,0.514,1.000,P＜0.05）.MSCT扫描及后处理的应用可有效显示结肠癌的部位、大小和形态,确定肿瘤侵犯范围、有无淋巴结及远处转移等,可以准确进行术前TNM分期,具有较高的临床应用价值.     

多层螺旋CT在结肠癌分期中的诊断价值分析

目的：探讨多层螺旋CT在结肠癌分期中的诊断效能以及应用价值。方法：将我院80例结肠癌患者采用多层螺旋CT进行检查,对比多层螺旋CT检查诊断表现,与病理诊断效果进行对照,分析其在结肠癌分期中的诊断价值。结果：80例患者中T1期肿瘤2例,估高2例;T2期肿瘤10例,CT分期正确6例,估高2例,估低2例;T3期肿瘤60例,CT分期正确56例,估高4例;T4期肿瘤8例,CT分期正确6例,估低2例。随访6个月存活74例,1年生存60例,2年生存41例,其中随访1、2年分期占比T1、T2患者生存率比较差异无统计学意义（P>0.05）,在T3、T4中随访2年生存率低于随访1年,差异有统计学意义（P <0.05）,说明随着T分期升高,生存率降低。结论：对结肠癌患者采用多层螺旋CT检查能够清晰显示癌灶分期,为临床治疗提供依据,但不同分期患者术后生存率具有一定的差异,分期升高,生存率降低。     

多层螺旋CT冠状动脉成像在冠心病诊断中的临床应用

近年来,冠心病(coronary artery disease,CAD)在我国的发病率明显增高,早期诊断、早期治疗尤为重要。随着计算机断层成像(CT)技术的迅速发展,多层螺旋CT(multidetector-row computed tomography,MDCT)逐步成为冠心病筛查和诊断的首选检查方法。现就MDCT的发展概况、钙化积分、检测冠状动脉狭窄程度、斑块评价、解剖变异显示、旁路血管评价、冠状动脉支架术后评价、心肌灌注、心功能分析等方面的临床应用进行综述     

多层螺旋CT在小肠扭转诊断中的应用

目的:评价多层螺旋CT在小肠扭转诊断中的应用价值.方法:对6例手术证实的小肠扭转多层螺旋CT和临床资料进行回顾性分析.结果:CT影像特征中,6例肠系膜血管呈漩涡征,3例为C形征,5例呈鸟嘴征,2例肠系膜上动、静脉呈现血管换位征,2例腹水征,1例肠系膜上静脉血栓.结论:多层螺旋CT可显示小肠扭转的典型表现,并为临床治疗提供帮助.     

多层螺旋CT在小肠扭转诊断中的应用

目的:评价多层螺旋CT在小肠扭转诊断中的应用价值.方法:对6例手术证实的小肠扭转多层螺旋CT和临床资料进行回顾性分析.结果:CT影像特征中,6例肠系膜血管呈漩涡征,3例为C形征,5例呈鸟嘴征,2例肠系膜上动、静脉呈现血管换位征,2例腹水征,1例肠系膜上静脉血栓.结论:多层螺旋CT可显示小肠扭转的典型表现,并为临床治疗提供帮助.     

直肠内充气CT在直肠癌诊断和临床分期中的意义

目的探讨直肠内充气CT在直肠癌诊断和临床分期中的意义。方法回顾性分析52例经手术病理证实直肠癌患者的直肠内充气CT表现,评价直肠内充气CT在直肠癌诊断和临床分期中的价值。结果直肠内充气CT患者直肠及乙状结肠充分扩张,包绕直肠周围脂肪密度结构,与相对较高密度的肠壁及极低密度肠腔对比清晰。直肠内充气CT对直肠癌TNM分期总的准确率为84.6%（44/52）,T分期的准确率为90.4%（47/52）,N分期的准确率为86.5%（45/52）,M分期的准确率为98.7%（51/52）。结论直肠内充气CT能够清晰显示直肠癌的大小,形态,浸润深度,淋巴结转移情况,与周围器官关系及远处转移情况,获得清晰的直肠系膜影像学特征。直肠内充气CT与TNM病理分期有较高的一致性,是直肠癌术前诊断与临床分期的重要方法。     

多层螺旋CT检查在结直肠肿瘤诊断中的应用

Colorectal neoplasms always present with thickness of the intestinal wall or a soft tissue mass in the enteric cavity. Multi-slice computed tomography (MSCT) with high spatial resolution and advanced post-processing techniques can demonstrate the above signs of the tumor, and the invasive signs of adjacent structures and lymph node metastasis. Combined with three dimensional reformation images, MSCT shows a higher sensitivity than that of double contrast barium enema and electronic colonoscope. MSCT is promising in the diagnosis and preoperative evaluation of colorectal neoplasms.     

Magnetic resonance colonography vs computed tomography colonography for the diagnosis of colorectal cancer: an indirect comparison

OBJECTIVE: The primary aim of this study was to use meta-regression techniques to compare the diagnostic accuracy of computed tomography colonography (CTC) and magnetic resonance colonography (MRC), compared with conventional colonoscopy for patients presenting with colorectal cancer (CRC). METHOD: Quantitative meta-analysis was performed using prospective studies reporting comparative data between CTC and MRC individually to conventional colonoscopy. Study quality was assessed and sensitivities, specificities, diagnostic odds ratios (DOR) were calculated. Summary receiver operating characteristic (SROC) curves and sensitivity analysis were utilized. Meta-regression was used to indirectly compare the two modalities following adjustment for patient and study characteristics. RESULTS: Overall sensitivity and specificity for CTC (0.96, 95% CI 0.92-0.99; 1.00, 95% CI 0.99-1.00 respectively) and MRC (0.91, 95% CI 0.79-0.97; 0.98, 95% CI 0.96-0.99 respectively) for the detection of CRC was similar. Meta-regression analysis showed no significant difference in the diagnostic accuracy of both modalities (beta=-0.64, P=0.37 and 95% CI of 0.12-2.39). Both tests showed high area under the SROC curve (CTC=0.99; MRC=0.98), with high DORs (CTC=1461.90, 95% CI 544.89-3922.30; MRC=576.41, 95% CI 135.00-2448.56). Factors that enhanced the overall accuracy of MRC were the use intravenous contrast, faecal tagging and exclusion of low-quality studies. No factors improved diagnostic accuracy from CTC except studies with more than 100 patients (AUC=1.00, DOR=2938.35, 95%CI 701.84-12 302.91). CONCLUSION: This meta-analysis suggested that CTC and MRC have similar diagnostic accuracy for detecting CRC. Study quality, size and intravenous/intra-luminal contrast agents affect diagnostic accuracies. For an exact comparison to be made, studies evaluating CTC, MRC and colonoscopy in the same patient cohort would be necessary.     

Contrast‐enhanced ultrasound vs multidetector‐computed tomography for detecting liver metastases in colorectal cancer: a prospective,blinded, patient‐by‐patient analysis

Aim This study compared the sensitivity and specificity of contrast‐enhanced ultrasound (CEUS) and multidetector‐computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer. Method Between September 2004 and December 2008, 271 consecutive patients (146 men and 125 women; median age 68 years, range: 34–91 years) with primary colorectal cancer were evaluated. All underwent combined liver ultrasound and CEUS following intravenous injection of 2.4 ml of SonoVue^TM. The interval from injection to arrival time in the hepatic vein (ATHV) was noted. Contrast‐enhanced MDCT in the portal phase was performed and interpreted blindly. In all patients, intra‐operative ultrasound was used as the reference point. In addition, magnetic resonance imaging (MRI) or biopsy was performed on all suspicious lesions or if there was inconsistency in the results. Results Liver metastases were detected in 21 (8%) patients. Both CEUS and MDCT had a sensitivity of 85.7%, with respective specificities of 97.6% and 95.6%, and positive predictive values of 75%vs 62%. The negative predictive value of both methods was 99%. In patients with and without liver metastases, ATHV was 18 and 22 s, respectively (P < 0.05). Conclusion CEUS has potential as a diagnostic alternative to MDCT in the detection of liver metastases. ATHV was shorter in patients with liver metastases.     

多层螺旋CT在胃癌术前分期中的临床应用

目的探讨多层螺旋CT（MSCT）在胃癌术前分期中的临床应用价值。方法2004年6月至2006年3月间经胃镜活检确诊为胃癌的患者89例，其中男性49例，女性40例，中位年龄63岁。所有患者均在手术前1周内进行MSCT检查。图像由2位资深放射科医师双盲阅读，术前判断患者的肿瘤TNM分期．并与患者的术后病理结果进行对照比较。结果与术后病理诊断比较，MSCT普通轴位图像结合多平面重建法判断胃壁侵犯程度的总准确率为72．3％，其中T1判断准确率为90．0％，T2为82．8％，T3为69．6％，T4为52．4％；判断淋巴结转移情况的总准确率为53．0％，其中N0判断准确率为44．0％，N1为72．0％，N2为46．4％，N3为2／5。MSCT对有远处转移即M1的患者判断准确率为90．0％。结论MSCT对胃癌患者进行术前TNM分期有较高的准确率，可以为胃癌患者术前提供一种无创且易于被接受的检查方法。     

The role of positron emission tomography in the management of colorectal cancer

Positron emission tomography (PET) is a functional imaging modality that has made the transition from the research enviroment to the clinical enviroment over the last 10 years. Its major role is in the field of oncology where it is being used increasingly in the management of several tumour types including colorectal cancer. This review aims to outline the current and future role of PET scanning in the field of colorectal cancer.     

Combined contrast-enhanced computed tomography and 18-fluoro-2-deoxy-D-glucose-positron emission tomography in the diagnosis and staging of non-small cell lung cancer

We present the current optimal uses and limitations of positron emission tomography/computed tomography (PET/CT) as it relates to the diagnosis and staging of non-small cell lung cancer (NSCLC). PET/CT demonstrates increased accuracy in the workup of solitary pulmonary nodules for malignancy compared with CT alone, and we discuss its benefits and limitations. We review pitfalls in measured standardized uptake values of lung lesions caused by respiratory artifacts, the lower sensitivity for detection of small lung nodules on non-breath-hold CT, and the benefits of obtaining an additional diagnostic CT for the maximum sensitivity of lung nodule detection. There are limitations of quantitatively comparing separate PET/CT examinations from different facilities with standardized uptake values. As for staging, we describe how PET/CT supplements clinical tumor-nodes-metastases (ie, TNM) staging, as well as mediastinoscopy, endobronchial ultrasound, and endoscopic ultrasound, which are the gold standard pathologic staging methods. We touch on the 7th edition TNM staging system based on the work by the International Association for the Study of Lung Cancer, an anatomically based staging method.     

The influence of 18F-fluorodeoxyglucose positron emission tomography/computed tomography on the N- and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma (ICC) is a highly metastatic cancer. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) enables sensitive tumor and metastasis detection. Our aim is to evaluate the influence of pre-treatment PET/CT on the N- and M-staging and subsequent clinical management in ICC patients.MethodsBetween August 2010 and August 2018, 660 consecutive ICC patients, without prior anti-tumor treatments nor other malignancies, were enrolled. The diagnostic performance of PET/CT on the N- and M-staging was compared with conventional imaging, and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated. Survival difference was compared between patients receiving PET/CT or not after propensity score matching.ResultsPatients were divided into group A (n=291) and group B (n=369) according to whether PET/CT was performed. Among 291 patients with both PET/CT and conventional imaging for staging in group A, PET/CT showed significantly higher sensitivity (83.0% vs. 70.5%, P=0.001), specificity (88.3% vs. 74.9%, P<0.001) and accuracy (86.3% vs. 73.2%, P<0.001) than conventional imaging in diagnosing regional lymph node metastasis, as well as higher sensitivity (87.8% vs. 67.6%, P<0.001) and accuracy (93.5% vs. 89.3%, P=0.023) in diagnosing distant metastasis. Overall, PET/CT improved the accuracy of preoperative staging from 60.1% to 71.8% (P<0.001), and modified clinical treatment strategy in 5.8% (17/291) of ICC patients, with unique roles in different tumor-node-metastasis (TNM) stages. High tumor-to-non-tumor ratio (TNR) predicted poor overall survival [hazard ratio (HR) = 2.17; 95% confidence interval (CI): 1.49–3.15; P<0.001]. Furthermore, patients performing PET/CT had longer overall survival compared with those without PET/CT (HR =0.74; 95% CI: 0.58–0.93; P=0.011) after propensity score matching.ConclusionsPET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients, and facilitated accurate tumor staging and optimal treatment allocation.     

结直肠癌患者门静脉血CK20mRNA检测的临床意义

目的:检测结直肠癌患者门静脉血CK20mRNA的表达情况,探讨其临床意义.方法:用实时定量荧光逆转录聚合酶链(FQ-PCR)方法,检测了72例结直肠癌患者门静脉及周围静脉血CK20mRNA的表达.结果:结直肠癌患者门静脉血CK20mRNA表达的阳性率72%(52/72)高于周围静脉血43%(31/72)(P＜0.001),结直肠癌DukesC、D期门静脉血CK20mRNA高于A、B期(P＜0.001).结论:门静脉血CK20mRNA表达的检测比周围静脉血检测更准确、敏感,是判断体内隐性播散和愈后的可靠方法.