Diagnostic Value of CT Colonography in Colorectal Carcinoma

OBJECTIVE To investigate the value of CT colonography (CTC) in diagnosis and preoperative staging of colorectal carcinoma. METHODS CTC was performed on 33 patients who were suspected of having colorectal carcinoma. The results of CTC were compared with those of a pathological examination. RESULTS Among the 22 patients who were diagnosed with colorectal carcinoma by CTC, 20 cases were confirmed by pathology. The diagnostic sensitivity and specificity were 100% (20/20) and 84.6% (11/13) respec- tively. The accuracy of showing carcinoma pathologic patterns was 90% (18/20). The sensitivity and specificity were both 100% in the mass type; 77.8% and 100% in the infiltrating type; 100% and 85.7% in the ulcerated type. The accuracy of staging Dukes' carcinoma was 75%. The sensitiv- ity and specificity were 100% and 94.1% for Dukes'A; 80% and 73.3% for Dukes' B; 60% and 100% in Dukes' C; 71.4% and 100% for Dukes' D. CONCLUSION CTC produces a high success rate and provides con- siderable diagnostic information for both an accurate diagnosis of colorectal carcinoma and staging before operation.     

微探头超声内镜和CT在胸段食管癌术前分期中的应用

Objective： To compare mini-probe endoscopic ultrasonography （MCUS） with computed tomography （CT） in preoperative T and N staging of esophageal cancer, and to find out the MCUS parameters to judge lymph nodes metastasis for esophageal cancer. Methods： Thirty-five patients received both MCUS and CT preoperatively, on both of which the T and N stages were determined. The accuracy, sensitivity, specificity, positive predicting value and negative predicting value were compared with the postoperative pathological results. Results： The accuracy of MCUS was 85.7% in T staging and 85.7% and 80.0% in N staging by two different methods, which were 45.7% and 74.3%, respectively, by CT. Conclusion： MCUS is better than CT in preoperative staging for esophageal cancer. The ratio of short to long axis （S/L） combined with short axis is a useful way to determine lymph nodes metastasis.     

Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis

Objective:Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis.The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis.Methods:Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer (cT≥2M0).We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy,and examined the relationship between peritoneal dissemination (P) and cytology results (CY).Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis.Multivariate logistic regression analysis and receiver-operator characteristic (ROC) analysis were performed in training set to find out risk factors of intra-abdominal metastasis,and then validate it in testing set.Results:Out of 249 eM0 patients,51 (20.5％) patients with intra-abdominal metastasis were identified by diagnostic laparoscopy,including 20 (8.0％) P1CY1,17 (6.8％) P0CY1 and 14 (5.6％) P1CY0 patients.In the training set,multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography (CT) scan ≥21 mm and tumor-occupied ≥2 portions of stomach are predictive factors of metastasis.In the testing set,when diagnostic laparoscopy was performed on patients who had one or two of these risk factors,the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0％ and 32.1％,respectively.Conclusions:According to our results,depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis.     

MRI结合数字化钼靶诊断乳腺癌的临床研究

ObjectiveTo compare the effectiveness of digital mammography and MRI in the detection and diagnosis of breast cancer and to assess the value of these modalities as well as the combination of the two.MethodsSixty-seven patients with surgery and pathology proved breast lesion (malignant,n＝32; benign,n＝46) underwent digital mammography and MRI,the pulse sequences included T1WI,T2Wl,diffuse weighted imaging (DWI),and dynamic contrast-enhanced MRI before surgery.Of the results of these two modalities,all lesions were classified into 5 groups according to BI-RADS classification,and the imaging findings were correlated to histopathology.The sensitivity and specificity of each modality as well as the combination of the two were calculated.ResultsOf these 78 breasts lesions,The sensitivity was 78.13%% (25/32) for digital mammography and 93.75% (30/32) for MRI (P＞0.05).The specificity was 73.91%% (34/46) and 89.13% (41/46) accordingly (P＜0.05),both of them showed statistical difference.The sensitivity and specificity was 98.63% and 97.16% respectively as these two modalities were used in combination.ConclusionDigital mammography in combination with MRI is helpful in the diagnosis of breast cancer,the sensitivity and specificity was enhanced when compared to that of single modality.     

双重超声造影在胃癌术前分期中的价值

Objective To evaluate the clinical value of double contrast-enhanced uhrasonography using oral and intravenous contrast agents in preoperative staging of gastric cancer.Methods Sixty-two patients with biopsy-proven gastric cancer were enrolled into this study,and were examined by double contrast-enhanced gastric uhrasonography preoperatively.The results were compared with postoperative pathologic findings.Results The accuracy of oral contrast-enhanced gastric uhrasonography and double contrast-enhanced ultrasonography in determining the T stage of gastric cancer was 72.9%(T1:66.7%,T2:60.0%,T3:76.9%,T4:71.4%)and 88.1%(T1:66.7%,T2:80.0%,T3:89.7%,T4:100%),respectively,with a statistically significant difference between the two methods(P =0.036).The sensitivity,specificity,accuracy and Youden index of oral contrast-enhanced gastric ultrasonography and double contrast-enhanced uhrasonography in assessment of lymph node metastasis were 74.5%,66.7%,72.9%,and 0.41 versus 89.4%,75.0%,86.4%,0.76,respectively.No significant difference in the accuracy of assessment for lymph node metastasis was observed(P ＞ 0.06).Conclusion Double contrastenhanced ultrasonography is useful for preoperative staging of gastric cancer,especially for T staging.     

Comparative study of CEA and CA19-9 in esophageal,gastric and colon cancers individually and in combination （ROC curve analysis）

Objective： To determine the clinical serum levels of carcinoembryonic antigen （CEA） and carbohydrate antigen 19-9 （CA19-9）, individually and in combination, for the diagnosis of 50 healthy subjects and 150 cases of esophageal, gastric, and colon cancers. Methods： The sensitivities of the two markers were compared individually and in combination, with specificity set at 100%. Receiver operating characteristic （ROC） curves were plotted. Results： Serum CEA levels were significantly higher in cancer patients than in the control group. The sensitivity of CEA was determined： in esophageal cancer, sensitivity=28%, negative predictive value （NPV）=61.72%, and AUC=0.742 （SE=0.05）, with a significance level of P〈0.0001; in gastric cancer, sensitivity=30%, NPV=58.82%, and AUC=0.734 （SE=0.0S）, with a significance level of P〈0.0001; in colon cancer, sensitivity=74%, NPV=79.36%, and AUC=0.856 （SE=0.04）, with a significance level of P〈0.0001. The sensitivity of CA19-9 was also evaluated： in esophageal cancer, sensitivity=18%, NPV=54.94%, and AUC=0.573 （SE=0.05）, with a significance level of P=0.2054. In gastric cancer, sensitivity=42%, NPV=63.29%, and AUC=0.679 （SE=0.05）, with a significance level of P〈0.0011. In colon cancer, sensitivity=26%, NPV=57.47%, and AUC=0.S80 （SE=0.05）, with a significance level ofP=0.1670. The following were the sensitivities of CEA/CA19-9 combined： in esophageal cancer, sensitivity=42%, NPV=63.29%, SE=0.078 （95% CI： 0.0159-0.322）; gastric cancer, sensitivity=S8%, NPV=70.42%, SE=0.072 （9$% CI： -0.0866-0.198）; and colon cancer, sensitivity=72%, NPV=78.12%, SE=0.070 （9S% CI： 0.137-0.415）. Conclusion： CEA exhibited the highest sensitivity for colon cancer, and CA19-9 exhibited the highest sensitivity for gastric cancer. Combined analysis indicated an increase in diagnostic sensitivity in esophageal and gastric cancer compared with that in colon cancer.     

The Use of Multislice Spiral CT to Predict the Resectability of Central Lung Cancer： Correlation with Pathologic and Surgical Findings

OBJECTIVE To assess the accuracy of multi-slice spiral CT （MSCT） with imaging reconstruction in judging central pulmonary vascular involvement from central lung cancer, and to explore its ability to predict the resectability of lung cancer. METHODS MSCTs were conducted on 48 patients who were diagnosed preoperatively with central lung cancer. Images of pulmonary arteries and veins that might affect Iobectomy or pneumonectomy were reconstructed by means of imaging processing techniques. Then the relationship of the tumor to the vessels was assessed prospectively on both axial CT images and axial CT images plus reconstructed images（CT-RI） in comparison to subsequent pathologic and surgical findings. RESULTS MSCTs were obtained on all 48 patients whom 42 underwent thoracotomy, Iobectomy or pneumonectomy. Compared with the axial CT images, CT-RI was more accurate in judging the relationship of the central pulmonary vessels to the tumor based on subsequent pathologic 78 vessels studied and surgical findings （186 vessels studied）（0.01 〈P〈0.05）. The sensitivity and positive predictive value of unresectability of the vessels were all remarkably higher with CT-RI （P〈0.01）. CONCLUSION MSCT with imaging reconstruction can improve the recognition of neoplastic invasion of central pulmonary vessels. It can be used to predict preoperatively the resectability of central lung cancer and to plan surgery.     

Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories

Objective： To determine the clinicopathological characteristics, and evaluate the appropriate extent of lymph node dissection in distal gastric cancer patients with comparable T category. Methods： A retrospective study was conducted on 570 distal gastric cancer patients, who underwent gastric resection with D2 nodal dissection, which was performed by the same surgical team from January 1997 to January 2011. We compared the differences in lymph node metastasis rates and metastatic lymph node ratios between different T categories. Additionally, we investigated the impact of lymph node metastasis in the 7th station on survival rate of distal gastric cancer patients with the same TNM staging. Results： Among the 570 patients, the overall lymph node metastasis rate of advanced distal gastric cancer was 78.1%, and the metastatic lymph node ratio was 27%. The lymph node metastasis rate in the 7th station was similar to that of perigastric lymph nodes. There was no statistical significance in patients with the same TNM stage （stage Ⅱ and Ⅲ）, irrespective of the metastatic status in the 7th station. Conclusions： Our results suggest that to a certain extent, it is reasonable to include lymph nodes in the 7th station in the D 1 lymph node dissection.     

Ⅰ、Ⅱ期子宫内膜癌MRI表现与病理对照研究

Objective： To analyze MRI features of FIGO stage Ⅰ and Ⅱ endometrial carcinoma and to study the value of MRI in assessing myometrial and cervical invasion of endometrial carcinoma. Methods： Thirty patients with surgicopathologically proven endometrial carcinoma were included in this retrospective study. All patients underwent Tl-weighted spin-echo, T2-weighted fast spin-echo and dynamic contrastenhanced fast multiplanar spoiled gradient echo sequences before surgery. The type, signal intensity and enhancement features of the tumors and the appearance of junctional zone or subendometrial enhancement were analyzed. The MRI diagnosis of myometrial and cervical invasion was correlated with pathologic findings.Results： Endometrial carcinoma demonstrated diffuse widening of endometrial stripe （n=14） or polypoid or large mass in the endometrial cavity （n=16）. The tumors were usually isointense relative to the myometrium on TlWI and hyperintensity on T2WI. In the first phase of dynamic contrast-enhanced sequences, diffuse endometrial carcinoma usually showed mild （n=8） or moderate （n=5） enhancement, while focal endometrial carcinoma tended to enhance markedly （n=6） or moderately （n=9）. On T2WI junctional zone was seen in 18 cases. On dynamic contrast-enhanced images subendometrial enhancement was seen in 17 cases. The sensitivity, specificity and diagnostic accuracy of dynamic contrast-enhanced images in combination with T2WI were 87.5%, 95.5% and 93.3% for assessing deep myometrial invasion, and 75%, 95.5% and 90% for assessing cervical invasion. Conclusion： MRI is accurate and reliable in the evaluation of myometrial and cervical invasion of endometrial carcinoma, and should be performed as preoperative routine examination.     

多排螺旋CT双期扫描三维重建技术胃癌评估(英文)

目的评价多排螺旋 CT 双期增强扫描三维重建技术在胃癌 TNM 分期中的诊断价值。方法 29例胃癌患者,术前采用一次闭气扫描技术,进行多排螺旋 CT 平扫和动脉期、静脉期双期增强扫描。扫描前15 min 肌注盐酸山莨菪碱20 mg,检查时口服产气粉两包。肘静脉团注对比剂后,进行增强扫描,得到的图像随后进行薄层重建,采用容积再现法(VR)、多层面容积重建法(MPVR),表面遮盖显示(SSD)和仿真内镜技术(CTVG)重建,结合原始图片 TNM 分期,与术后病理相对照,评价在胃癌 TNM 分期中的诊断价值。结果 29例胃癌患者,T 分期:T_1期敏感性为50%,特异性50%,T_2期敏感度为87.5%,特异度77.8%,T_3期敏感度为83.3%,特异度76.9%,T_4期敏感度为100%,特异度80%。在 N 分期上,N_0期敏感度为83.3%,特异度71.4%,N_1期敏感度为87.5%,特异度77.8%,N_2～N3期敏感度为81.8%,特异度75%。M_1期敏感度和特异度均为100%。结论多排螺旋 CT 双期增强扫描结合重建技术能够较好地进行 TNM 分期,有效地指导手术方案的选择。     

64排螺旋CT多期增强扫描对进展期胃癌术前评估的价值

目的探讨64排螺旋CT三期增强扫描对进展期胃癌术前评估中的价值。方法选择CT检查前已确诊为胃癌的患者80例,术前行64排螺旋CT三期增强扫描,然后进行病理分期TNM分期,分析螺旋CT与病理分期的效果,并且探讨增强CT对于手术判断的效果。结果CT影像学主要表现为胃壁异常增厚、肿瘤向周围直接侵犯、局部和远处淋巴结转移,CT与病理诊断对比在T分期与N分期上有显著性差异（P〈0．05）,而对M分期对比上无明显差异（P〉0．05）。CT预测治疗方式与临床相符合的敏感度为78．6％,特异性为86．5％,准确率为83．8％。结论多层螺旋CT（MSCT）可较准确地显示胃癌侵犯胃壁的深度、淋巴结转移和远处脏器的转移情况,在胃癌M分期判断上有较高的准确率,能为手术治疗方案选择提供参考。     

胃癌螺旋CT征象与病变危险度的相关性研究

目的探讨胃癌螺旋CT征象与病变危险度的相关性。方法选取经病理检查确诊为胃癌的72例患者的临床资料,分析所有患者的胃癌螺旋CT征象与TNM分期,并与术后病理结果进行对照性研究。结果在72例患者中,病理分期判断为T1期15例、T2期20例、T3期15例、T4期22例;螺旋CT对胃癌T分期总的准确性为95.8%,Kappa值为0.943。病理分期判断为N0期25例、N1期31例、N2期16例;螺旋CT对胃癌N分期总的准确性为88.9%,Kappa值为0.832。病理分期判断为M0期57例、M1期15例;螺旋CT对胃癌M分期总的准确性为94.4%,Kappa值为0.872。胃癌螺旋CT TNM分期结果与病理结果一致性都好。结论螺旋CT征象在胃癌的术前诊断应用能有效评价患者的TNM分期状况,可反映病变危险度,有很好的临床诊断价值。     

术前CT检查在可手术非小细胞肺癌TNM分期中的应用评价

目的比较术前CT检查和术后病理诊断的非小细胞肺癌TNM分期结果,评价术前CT检查对非小细胞肺癌TNM分期的临床参考价值。方法112例临床确诊为NSCLC的患者行术前螺旋CT检查,临床分期为Ⅰ～ⅢA患者行手术切除加系统性淋巴结清扫,术前CT检查对TNM的分期结果定义为临床TNM（cTNM）,术后的病理分期定义为病理TNM（pTNM）。对比患者的cTNM与pTNM,评价术前CT检查确定非小细胞肺癌TNM分期的敏感度、特异性和准确率。结果（1）术前CT检查诊断T分期的敏感度和特异性分别为76.6％和85.7％,阳性预测值为92.2％,阴性预测值为62.5％,准确率为79.5％。一致性检验有统计学意义（Kappa=0.658,P<0.05）;（2）术前CT检查诊断纵隔淋巴结转移的敏感度和特异性分别为72.9％和84.9％,阳性预测值为84.3％,阴性预测值为73.8％,准确率为78.6％,一致性检验有统计学意义（Kappa=0.667,P<0.05）。螺旋CT检查诊断 4R、5、6 组纵隔淋巴结转移的准确率和特异性偏低,其中4R组淋巴结转移的假阳性和假阴性较高。结论术前CT检查对非小细胞肺癌TNM分期有重要的临床参考价值,但存在假阳性和假阴性,应结合其他检查手段如PET-CT或纵隔镜等提高术前TNM分期准确率。     

多层螺旋CT在直肠癌术前分期中的诊断价值

背景与目的:直肠癌术前分期对选择合理治疗方案和判断预后至关重要。传统的计算机断层扫描(computed tomography,CT)对直肠癌术前分期存在争议,本研究旨在探讨多层螺旋CT(multislice spiral CT,MSCT)对直肠癌术前分期的诊断价值。方法:中山大学肿瘤防治中心2006年3月至2007年2月,经病理证实的直肠癌患者87例,所有患者术前行MSCT平扫及增强扫描,由两位放射科医生独立评价肿瘤的部位、大小、侵犯范围(T)、淋巴结转移(N)及远处转移(M)情况,做出诊断及TNM分期,并与术后病理对照,评价准确性、灵敏度及特异度。结果:MSCT检出了全部87例直肠癌,对直肠癌TNM分期总的准确性为81.6%(71/87)。T、N、M期准确性分别为94.3%(82/87)、82.8%(72/87)、98.9%(86/87)。≤T2、T3、T4期灵敏度分别为90.5%、91.3%、97.7%,特异度分别为98.5%、94.2%、97.7%。N0、N1、N2期灵敏度分别为92.9%、72.0%、82.4%,特异度分别为88.9%、88.5%、91.7%。远处转移的患者仅1例因肝脏转移灶<5mm而漏诊。结论:MSCT能较准确地判断直肠癌的侵犯范围、淋巴结转移及远处转移,是非常有价值的术前分期方法。     

飞利浦64排增强CT扫描在胃癌术前分期中的应用

目的:分析飞利浦64排增强CT扫描在胃癌术前分期中的应用价值。方法:选取我院2016年1月至2018年1月收治的450例经胃镜检查证实的胃癌患者纳入研究，术前采取飞利浦64排增强CT扫描方式评估TNM分期，以术后病理检查结果作为“金标准”，分析飞利浦64排增强CT扫描在胃癌术前分期中的准确性。结果:飞利浦64排增强扫描T1期灵敏度为64.00%，特异度99.06%，准确性97.11%，Kappa值0.70；T2期灵敏度为70.65%，特异度94.97%，准确性90.00%，Kappa值0.68；T3期灵敏度为83.93%，特异度81.42%，准确性82.67%，Kappa值0.65；T4期灵敏度为70.64%，特异度88.27%，准确性84.00%，Kappa值0.57；飞利浦64排增强扫描N0期灵敏度为80.25%，特异度85.85%，准确性82.89%，Kappa值0.66；N1期灵敏度为77.16%，特异度92.36%，准确性86.89%，Kappa值0.71；N2期灵敏度为84.00%，特异度90.00%，准确性89.33%，Kappa值0.58；飞利浦64排增强扫描M分期检查灵敏度为96.62%，特异度93.85%，准确性96.22%，Kappa值0.86。结论:依据飞利浦64排增强CT扫描结果进行胃癌术前TNM分期，与术后病理检查一致，其中M分期检查准确性最高，与术后病理一致性极好，可为患者治疗方案的合理选择提供重要参考。     

多层螺旋CT与内镜超声检查对胃癌的术前评估价值比较

目的:比较多层螺旋CT与内镜超声检查对胃癌的术前评估价值。方法:采用回顾性总结研究方法，选择2014年6月至2018年1月在我院普外科手术切除并经病理证实的胃癌患者66例作为研究对象，记录所有患者的多层螺旋CT与内镜超声检查结果，并与病理检查结果进行对比分析。结果:在66例患者中，T分期为T1期6例，T2期14期，T3期30例，T4期16例；N分期为N0期16例，N1期14期，N2期36例；M分期为M0期46例，M1期20期。内镜超声对TNM分期判断准确率分别为92.4%、92.4%和93.9%，CT对TNM分期判断准确率分别为93.9%、97.0%和98.5%，CT都好于内镜超声，但是对比差异无统计学意义(P＞0.05)。结论:多层螺旋CT与内镜超声检查在胃癌TNM分期的术前评估都有较高的准确率，在临床上可结合两者方法共同使用，以提高诊断效果。     

螺旋CT后处理技术在肺癌新分期中的临床价值

Objective:To evaluate the role of spiral CT imaging postprocessing techniques in preoperative TNM staging of lung cancer.Methods:106 patients with pathologically confirmed lung cancer received spiral CT examinations with a new revised TNM staging method of lung cancer which was taken as criterion of diagnosis.The images were reconstructed by using different postprecessing techniques such as MPR,MIP,SSD,VR,and their TNM staging capabilities were assessed by using postprocessing imaging and the results with axial CT images were compared.Results:In T staging,the accurate rates of axial CT images in T1-T4 staging were 77.3%,60.6%,60.7%,and 60.3% respectively; for postprocessing images,the accurate rates were 86.4%,90.9%,89.3%,and 87.0% respectively.In N staging,the accurate rates of axial CT images were 84.6%,68.1%,63.6%,and 64.2% in NO-N3 staging,respectively; but they were 92.3%,90.9%,90.9%,and 85.7% in postprocessing images,respectively.The postprocessing images were superior to axial CT images in T1-T3 and N1-N3 staging of lung cancer but there were no significant differences in T1 and NO staging.For metastasis,the postprocessing images may be helpful for the TNM staging of lung cancer.Conclusion:The postprocessing techniques of the spiral CT could improve the accurate rates of TNM staging of lung cancer,and represent a useful complement to the axial CT.     

双期动态CT扫描和腹部B超对胃癌术前TNM分期的评价

目的 评价双期动态ＣＴ扫描和腹部Ｂ超以及两者相结合对胃癌术前分期的诊断价值。     

64排螺旋CT三期增强扫描在判断胃癌浸润深度的临床价值

目的:探讨64排螺旋CT三期增强扫描在术前判断胃癌浸润深度的临床价值。方法:确诊为胃癌的65例患者,术前均通过64排螺旋CT三期增强扫描判断胃癌浸润的深度,与术中探查及术后病理结果进行对比。结果:65例胃癌患者术前行64排螺旋CT三期增强扫描,通过与术中探查及术后病理对比,对胃癌T分期总的准确率为84.62%（55/65）,T1期为83.33%（5/6）,T2-3期为89.47%（34/38）,T4a期为75%（12/16）,T4b期为80%（4/5）。 结论:64排螺旋CT三期增强扫描在术前判断胃癌浸润深度的准确度高,为判断能否手术切除提供可靠的依据。