低张水灌肠多层螺旋CT对大肠癌分期的临床研究

目的探讨低张水灌肠多层螺旋CT（MSCT）动态增强扫描对大肠癌分期的诊断价值。方法对60例内镜诊断或怀疑大肠癌的患者行MSCT动态3期增强扫描，以横断面图像为基础，结合多平面重组（MPR），进行TNM分期，与术后病理对照。结果53例大肠癌有分期研究价值。MSCT检出了全部大肠癌，敏感度为100％，对大肠癌TNM分期的准确度为83.0％（44／53），其中T分期准确度为94．3％（50／53），N分期的准确度为86．8％（46／53），M分期的准确度为98．1％（52／53）。结论MSCT可以有效地显示大肠癌的部位、大小和形态，能较准确地确定中晚期大肠癌的侵犯范围和肝脏转移，TNM分期准确度较普通螺旋CT有明显提高；增强门脉期或平衡期对TNM分期准确度差异无统计学意义。     

螺旋CT对大肠癌分期诊断及病理对照研究

目的:评估螺旋CT平扫、增强扫描及图像后处理技术在大肠癌术前分期中的价值。方法:对临床诊断大肠癌患者进行X线钡剂造影、螺旋CT平扫、增强扫描和图像后处理(SSD、MPR、CTVE等),对其进行CT分期并与术后病理TNM分期进行对照,对其中有手术、纤维结肠镜活检病理资料完整的110例进行回顾性分析。结果:本组病例对大肠癌T分期的符合率为63.6%,其中T0-2分期符合率仅为28.6%(8/28),T3分期符合率为81%(56/69),T4分期为96%(26/27);N分期诊断符合率为12.7%;M分期的诊断符合率为98.2%。结论:螺旋CT平扫、增强扫描及图像后处理技术,能较好地诊断肠腔内病变、病变的浸润及转移情况,并可进行大肠癌术前分期,尤其对于远处转移M分期的诊断具有明显优势。但对于T分期和N分期的诊断,仍有待于进一步提高。     

周围型肺癌的CT征象与E-cadherin表达的相关性研究

目的 探讨周围型肺癌CT征象与E钙黏附蛋白(E-cad)表达间的关系. 方法 本组58例周围型肺癌患者,均采用螺旋扫描.标本4 μm连续切片,采用免疫组织化学S-P法检测肿瘤组织E-cad的表达.实验数据经SPSS10.0统计软件包进行统计学处理. 结果 E-cad异常表达32例,细胞分化Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组阳性表达率分别为40.63%和73.08%,2组间比较差异具有统计学意义(P＜0.05).肺癌E-cad的异常表达与肿瘤的大小、棘突征、胸膜侵犯、淋巴转移明显相关(P<0.05).而与毛刺征、血管集中征、空洞征、胸膜凹陷征、分叶征无关(P>0.05). 结论 E-cad异常表达在肺癌的发生、发展及CT表现中可能起重要作用.     

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。     

结肠癌64层螺旋CT增强表现及其病理对照研究

目的评价结肠癌的64层螺旋CT(64-SCT)动态强化表现,并与病理进行对照。方法通过对56例结肠癌病人进行64-SCT动态强化扫描,先按64-SCT动脉期强化扫描图像的不同表现进行分类,然后再对各病例进行诊断及术前评估并与其病理进行对照研究。结果56例结肠癌患者的64-SCT动脉期强化图像有特异性表现,分化好的肿瘤动脉期肿瘤呈轻、中度均质强化,本组共23例;分化差的肿瘤动脉期肿瘤呈明显的不均质强化或层状强化,本组共33例,以此为依据对所有肿瘤进行CT分期。64-SCT分期的准确性为91.07%,术前评估的准确性为92.86%。结论64-SCT动态强化扫描在结肠癌的诊治中,具有独特的优越性。     

结肠绒毛状肿瘤的CT表现

目的 探讨结肠绒毛状肿瘤CT表现,以提高对该肿瘤的鉴别诊断水平.方法 回顾性分析经病理证实的8例结肠绒毛状肿瘤(包括绒毛状腺瘤和绒毛管状腺瘤)的CT表现.8例均为单发,其中男3例,女5例,8例均行CT平扫加增强检查.结果 8例中病变位于升结肠1例,乙状结肠2例,直肠5例.8例中有3例表现比较典型,增强后可见脑回状、树叶状表现,余5例病变呈息肉状.1例直肠腺瘤局部癌变,余7例为良性病变,其中4例合并不同程度不典型增生.结论 结肠绒毛状肿瘤CT表现形式多样,CT可以诊断典型的绒毛状肿瘤.     

直肠少见恶性肿瘤的CT表现

目的：分析直肠少见恶性肿瘤的CT表现,以提高对该类疾病的认识。方法：回顾性分析经临床及病理学证实的12例直肠少见恶性肿瘤的CT资料。结果：12例均为单发。6例间质瘤多表现为直肠腔外为主生长的结节或肿块,增强扫描较明显延迟强化;4例神经内分泌肿瘤表现为直肠肠壁结节或肿块,增强扫描明显持续强化;1例恶性神经鞘瘤表现为直肠下段肠壁不规则团块样增厚,增强扫描不均匀较明显强化;1例肾透明细胞癌直肠转移表现为单发类圆形结节突入肠腔,增强扫描呈现"快进快出"的强化模式类似于肾透明细胞癌。1例巨大间质瘤伴前列腺癌,1例神经内分泌肿瘤并发肝脏多发转移,1例肾透明细胞癌直肠转移同时发现胰腺及右侧肾上腺转移。结论：直肠少见恶性肿瘤的种类较多,CT可显示不同肿瘤的病理改变,对该类疾病的诊断及鉴别有较大价值,但最终仍需病理学确诊。     

多层螺旋CT扫描在结直肠癌诊断和术前分期中的应用价值

目的:评价多层螺旋CT扫描(MSCT)在结直肠癌诊断和术前分期中的应用价值。方法:回顾性分析经手术或常规结肠镜活检病理证实的40例结直肠癌的多层螺旋CT表现,并与病理结果对照。结果:病理证实结直肠癌40例(其中盲肠癌6例,升结肠癌3例,横结肠癌3例,降结肠癌5例,乙状结肠癌1例,直肠癌22例),多层螺旋CT检出了全部结直肠癌,敏感性为100%,总的分期准确率为80%(32/40),B期分期准确率为83.3%(15/18),C期分期准确率为66.7%(8/12),肿瘤浆膜外侵犯的敏感性和特异性分别为95%(36/34)和50%(2/4),淋巴结转移的敏感性和特异性分别为60%(12/20)和90%(9/10)。结论:多层螺旋CT扫描(MSCT)可以有效地显示结直肠癌的部位、大小和形态、确定中晚期结直肠癌的侵犯范围、远处转移及淋巴结转移等,从而更准确地诊断并进行术前分期,具有较高的临床应用价值。     

脂肪对比剂灌肠多层螺旋CT对大肠癌分期的临床分析

目的 探讨脂肪对比剂灌肠多层螺旋CT(MSCT)对大肠癌分期的诊断价值.方法 对33例内镜活检证实的大肠癌患者,扫描前充分肠道准备、肌注低张剂后,经直肠导管注入脂肪对比剂(CT值-200～ -240 HU)1500 ml,行MSCT动态增强扫描,以横断面图像为基础,结合多平面重组(multiplanar reconstruction,MPR)及CT仿真内窥镜(CT virtual endoscopy,CTVE),进行TNM分期,并与术后病理对照.结果 术前MSCT诊断大肠癌33例,TNM总分期准确度为78.78%(26/33),其中T分期敏感度为100%,阳性诊断准确度为87.88%(29/33);N分期敏感度为86.36%(19/22),阳性诊断准确度为68.18%(15/22).5例肝脏转移的患者均被CT检查发现.结论 脂肪对比剂多层螺旋CT对大肠癌分期有重要意义.     

乳腺癌的多层螺旋CT表现与C-erbB-2、ER、PR表达的相关性研究

目的:探讨乳腺癌的多层螺旋CT表现与C-erbB-2、ER、PR表达之间的相关性。方法:回顾性分析72例经手术病理证实为乳腺癌的患者的多层螺旋CT表现,患者术前皆未行化疗或放疗,术后标本行免疫组织化学染色测定肿瘤细胞C-erbB-2、ER、PR的表达情况,并分析其与相应病灶多层螺旋CT表现的关系。结果:乳腺癌的多层螺旋CT主要征象表现为边缘形态不规则呈浅分叶或毛刺状边缘,边界模糊,瘤内有坏死、细沙砾样钙化,增强后不均匀强化为主,可伴有腋窝淋巴结转移,表现为淋巴结直径增大,长短径比例小于2,淋巴结实变,实质厚度不均,淋巴结边缘模糊。乳腺癌病灶的大小、钙化、淋巴结转移与C-erbB-2阳性表达正相关(P0.05),毛刺状边缘与ER、PR阳性表达呈正相关(P0.05)。结论:乳腺癌的多层螺旋CT表现与分子生物学指标C-erbB-2、ER、PR之间存在一定的相关性。乳腺癌的多层螺旋CT表现在一定程度上反映了乳腺癌细胞的生物学行为,对乳腺癌的预后评估具有较重要的临床价值。     

18F-FDG PET/CT显像与结直肠癌治疗前分期的相关性研究

目的评价结直肠癌原发灶最大标准化摄取值（SUV_max）与临床病理资料、TNM分期、临床分期的相关性。方法回顾性分析83例已确诊的结直肠癌患者资料,所有患者均于治疗前1周内行18F-FDG PET/CT检查,并测量原发灶SUV_max,采用单因素方差分析及两独立样本t检验进行组间比较。采用Spearman相关分析评价SUV_max与TNM分期及临床分期的相关性。结果原发灶SUV_max与肿瘤长径（t=2.497,P < 0.05）、病理及分化程度有关（F=3.727,P < 0.05）;不同T分期结直肠癌原发灶的SUV_max差异无统计学意义（F=2.492,P>0.05）;不同N分期、M分期、临床分期结直肠癌原发灶的SUV_max差异有统计学意义（t=2.081、2.168、F=2.839,均P < 0.05）;原发灶SUV_max与T分期无相关性（r=0.004,P>0.05）,与N分期、M分期、临床分期呈正相关（r=0.248、0.273、0.324,均P < 0.05）。结论结直肠癌原发灶SUV_max与肿瘤长径、病理及分化程度、N分期、M分期、临床分期有关,可反映肿瘤的增殖、侵袭能力。     

CT纹理分析与结肠癌术后TNM分期的相关性分析

目的 探讨结肠癌CT纹理分析与术后TNM分期的相关性.方法 回顾性分析99例结肠癌患者的术前CT图像.选取横断位图像病灶最大层面手动勾画ROI.通过Mann-Whitney U检验评估不同TNM分期的纹理参数差异性.采用ROC曲线分析评估CT纹理参数在区分TNM不同分期的诊断效能.结果 静脉期min在T1-2和T3-4...     

Helical CT imaging of gastric cancer: normal wall appearance and the potential for staging

PURPOSE: To evaluate the CT appearance of the normal gastric wall and the effectiveness of contrast enhanced helical CT for T-staging of gastric cancer. METHODS: For the basic experiment, two resected stomachs with gastric cancer were filled with water and examined by helical CT imaging. For the clinical study, 59 consecutive patients with gastric cancer who had received preoperative helical CT examination and had also been operated on were entered in this study. Helical CT images were evaluated independently by three radiologists without knowledge of histological staging results. RESULTS: The basic examination of a histopathological correlation with CT images revealed that the inner layer with high attenuation corresponded to the mucosa and the muscular layer of the mucosa, the middle layer with low attenuation to the submucosal layer consisting of coarse tissues and containing fatty tissues, and the outer layer with slightly high attenuation to the proper muscle with serosa. The clinical study revealed that the rate of correct diagnosis through consensus reading was 66.1%. CONCLUSION: The entire stomach with a well-stained mucosa can be visualized by contrast enhanced helical CT. However, T-staging of gastric cancer by helical CT did not appear to improve the accuracy of staging.     

低张水灌肠低剂量螺旋CT对结直肠癌诊断及分期的分析

目的 评估低张水灌肠低剂量多层螺旋CT(multi-slice spiral CT,MSCT)平扫及二期增强扫描在结直肠癌术前诊断及分期的价值.方法 对49例临床高度怀疑结直肠癌的患者进行低张水灌肠MSCT检查,扫描参数:管电压120 kV,管电流70 mA,并进行TNM分期,与术后病理比较,分析MSCT分期的准确性.结果 MSCT对所有癌灶显示率为100%,共检出癌灶50处,其中多原发癌1例,5例合并息肉,准确率为T分期74.0%(37/50),N分期62.0%(31/50),M分期为98.0%(48/49).与本CT机常规扫描剂量(120 kV,220 mA)相比较容积CT剂量指数(volume computed tomography dose index,CTDIvol) 及剂量长度乘积(dose length product,DLP)降低68.2%.结论 低张水灌肠低剂量MSCT对结直肠癌的术前诊断及分期可以提供较全面的信息,同时减少辐射剂量,是结直肠癌的术前重要检查方法.     

Performance of integrated FDG-PET/contrast-enhanced CT in the staging and restaging of colorectal cancer: Comparison with PET and enhanced CT

Objective

The purpose of this study was to assess the diagnostic value of PET/CT as a one step examination in patients with colorectal cancer. Therefore we proved whether diagnostic PET/CT adds information over PET or contrast-enhanced CT alone for staging or restaging of patients with colorectal cancer.

Methods

Seventy-three patients (46 males and 27 females; age range: 50-81 years; mean age: 67 years) with known colorectal cancer underwent 18F-FDG-PET/CT for staging or restaging.

Results

Of the 73 patients 26 patients underwent PET/CT for staging and 47 for restaging. 266 metastases could be detected in 60 patients. Contrast-enhanced PET/CT had a lesion-based sensitivity of 100%, contrast-enhanced CT of 91% and PET of 85%. PET/CT identified 2 lesions as false positive. PET/CT could also reach a patient-based sensitivity of 100%, which was superior to contrast-enhanced CT and PET.

Conclusion

Our study clearly demonstrated the added value of contrast-enhanced PET/CT in staging and restaging patients with colorectal cancer over CT and PET alone.     

CT staging of colon cancer

Computer tomography (CT) has been the principal investigation in the staging of colon cancers. The information obtained with routine CT has been limited to identifying the site of the tumour, size of the tumour, infiltration into surrounding structures and metastatic spread. The Foxtrot trial National Cancer Research Institute (NCRI) has been specifically designed to evaluate the efficacy of neoadjuvant treatment in colon cancers by using preoperative chemotherapy with or without an anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody to improve outcome in high-risk operable colon cancer. Patients are selected based on their staging CT examination. The criteria for poor prognosis are T4 and T3 tumours with more than 5mm extramural depth. Thus the success of the trial would depend upon the confidence of the radiologist to identify the patients that would receive the neoadjuvant treatment. The aim of this review is to explain the process of identifying high-risk features seen on the staging CT images. This will help to identify a cohort of patients that could truly benefit from neoadjuvant strategies.     

Bladder cancer: staging with CT and MR imaging

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in 30 patients with histologically proved bladder cancer. MR imaging was accurate in depicting the presence or absence of extravesical spread in 22 patients (accuracy, 73%; sensitivity, 82%; specificity, 62%), and CT was accurate in 24 patients (accuracy, 80%; sensitivity, 94%; specificity, 62%). The MR examinations of two patients were of undiagnostic quality and therefore considered to be technical failures. Each technique resulted in five false-positive and one false-negative examination for the diagnosis of extravesical tumor spread. In 28 patients the integrity of the bladder wall was assessed with MR imaging. In 22 patients the bladder wall was disrupted, and 18 of these patients had deep muscle invasion. In six patients the bladder wall was intact, and none of these patients had evidence of deep muscle invasion at pathologic examination. In this study MR imaging was slightly inferior to CT in the delineation of invasive tumors beyond the bladder wall. However, if one excludes from analysis the two patients with undiagnostic studies, there is no significant difference in accuracy between the two techniques.     

膀胱癌的CT分期与病理对照

目的 分析膀胱癌的CT表现，并与手术病理对照，提高膀胱癌的术前分期诊断水平。方法分析13例膀胱癌的CT表现及术前分期，并与手术病理结果对照。结果膀胱癌主要表现为膀胱壁局限性或弥漫性增厚，形成菜花样肿物向腔内突出，可向壁外生长侵犯盆腔组织器官及淋巴结转移，膀胱周围脂肪间隙模糊。膀胱癌的术前CT分期正确率为69．3％。结论螺旋CT扫描能显示膀胱癌的CT特征及向膀胱壁内、外生长情况，对术前分期有意义。