结肠胶囊内镜在结直肠癌筛查中的应用

结直肠癌是危害人民健康的一种常见恶性肿瘤,筛查是降低结直肠癌发病率和病死率最有效的手段。结肠镜检查是结直肠癌筛查指南中推荐的首要方法,但依从性欠佳。结肠胶囊内镜是一种新开发的非侵入性结肠内镜检查技术, 舒适性较传统的结肠镜检查明显提升。本文对结肠胶囊内镜在结直肠癌筛查中的应用情况做一综述。     

CT模拟结肠镜在结肠病灶诊断中的应用

结肠癌是常见的消化道肿瘤,上海等地区的发病率有明显增高的趋势。在发达国家,结肠癌占肿瘤死亡率第二位,且与大肠腺瘤关系密切。如能早期发现有恶变先兆的息肉并切除之,可以预防结肠癌发生。目前,对结肠癌发病高危人群并未作大规模普查,部分由于患者缺乏早期主诉,或是由于现有普查手段不够有效。大便隐血试验只能发现３０％～４０％结肠肿瘤,乙状结肠镜不能进入近端结肠,并有１０％～１５％乙状结肠肿瘤漏诊。钡剂灌肠和结肠镜能检查全结肠,但有１０％～１５％患者行结肠镜检查失败,并且结肠镜可能使１０％～２０％病灶遗漏,尚…     

结肠镜普查及随访对老年人早期结直肠癌的诊断价值

目的 通过对老年人进行结肠镜临床普及及随访,提高老年人结直肠癌的防治水平。方法 结合每年查体对2196例60－89岁老年人进行结肠镜临床普查及随访,结肠镜随访1740例,随访率为79．2％。结果 共检出结直肠癌52例,检出率为2．4％,早期结直肠癌19例,占36．5％,结肠镜随访中检出早期结肠癌9例,占随访检出直肠癌20例的45．0％。结直肠癌手术切除率及术后5年生存率分别为97．7％和80．9％。结肠镜插镜成功率为98．9％,并发症的发生率为0．05％。结论 开展老年人结肠镜临床普查及随访,使结直肠癌及癌前病变－－腺瘤性息肉患者得到了早期诊断,提高了早期结直肠癌的检出率及结直肠癌的Ⅱ级防治水平。     

双源CT与MRI在结直肠癌术前分期中的临床价值分析

目的 探究对结直肠癌(CRC)患者应用双源CT、MRI检查对其术前分期的诊断效能。方法 以2020年4月至2022年4月德阳市人民医院收治的102例CRC患者为研究对象,分别采用MRI、双源CT进行扫描检查;依据病理检查结果分析双源CT、MRI的诊断正确率;采用ROC曲线比较双源CT与MRI在CRC患者中的诊断价值。结果 MRI检查结果显示,肿瘤分期T_1～2、T₃、T₄、N₀、N₁、N₂的诊断正确率分别为90.91%、87.23%、86.36%、92.50%、88.57%、77.77%。双源CT检查结果显示,T_1～2、T₃、T₄、N₀、N₁、N₂的诊断正确率分别为75.76%、78.72%、72.73%、75.00%、80.00%、62.96%。对比双源CT,MRI在CRC患者中的ROC曲线下面积、敏感度和特异度明显升高(P&...     

螺旋CT用于诊断结直肠癌84例报告

2005年6月以来，我们在84例结直肠癌患者术前进行螺旋CT检查，诊断效果较好。现报告如下。     

CT诊断血吸虫病结肠病变9例

血吸虫病结肠病变的影像学检查既往多为X线结肠双对比造影，CT用于血吸虫病结肠病变检查的报道较少，我们总结9例经结肠镜活检病理证实或粪便虫卵阳性确诊的慢性血吸虫病结肠病变的CT资料，分析其对血吸虫病结肠病变的诊断价值。     

低剂量16层螺旋CT结肠成像对结直肠癌的诊断价值

目的评价低剂量16层螺旋CT结肠成像（multisliceCTcolonlgraphy，MSCT）对结直肠癌的诊断应用价值。方法对37例经临床拟诊为结直肠癌患者行结肠充气的低剂量50mAs16层螺旋CT扫描（MSCT），利用工作站的后处理软件可获得多平面重建（multiplanarreformation，MPR）。三维表面遮盖显示（shaded．surfacedisplay，SSD）和透明显示像及CT仿真结肠内镜图像（CTVC）及结直肠黏膜剖开图像，将低剂量MSCT诊断结果与结直肠镜或手术病理进行对比。结果37例经手术或结直肠镜病理证实结肠癌29例和非结肠癌8例，低剂量MSCT正确诊断29例结肠癌病例（包括并发病灶及转移灶）中的28例和8例非结直肠癌中的5例，诊断的敏感度、特异度和准确度分别为：96．55％（28／29），62．5％（5／8），89．19％（33／37）。结论低剂量MSCT是安全、无创、快速、全面评价结直肠癌的方法，可以完全替代钡剂灌肠检查，是结直肠癌筛选、术前分期、预后评估及术后随诊的首选方法。     

CT仿真结肠镜在结直肠病变诊断中的应用价值

目的探讨评估CT仿真结肠镜(CT Virtual Colonscopy,CTVC)在结肠息肉、结肠癌、溃疡性结肠炎、结肠黑变病中的检出能力，初步评阶其在结直肠病灶中的临床应用前景。方法对44例病人行CTVC检查，并与全结肠镜、病理结果进行对比研究。结果CTVC对结肠癌、结肠息肉具有较高辨别力，成功检出了全部10例结肠癌，并得到病理证实。10mm以上结直肠息肉CTVC与结肠镜都做出了正确诊断，CTVC发现5～10mm息肉14枚，＜5mm息肉CTVC仅发现2枚；CCTV发现2例。溃疡性结肠炎，结肠黑变病未检出。结论CTVC在结直肠癌和＞5mm以上结直肠息肉样病变诊断上具有较高的临床应用价值。     

窄带成像内镜技术在结直肠病变诊断中的应用

结直肠肿瘤的发病率和死亡率近年呈明显上升的趋势,因此早期诊断和治疗结直肠肿瘤显得十分重要。窄带成像内镜技术作为一种新的内镜下诊断技术,已初步显示出其对结直肠病变的诊断价值。本文就窄带成像内镜技术的原理及其诊断结直肠病变的作用作一综述。     

CT结肠造影的应用现状及前景

CT结肠造影(computed tomography colonography, CTC)为新近发展起来地结直肠病变检查手段, 是用多排螺旋CT技术将充气扩张的全结肠薄层扫描后的原始数据经相应的计算机软件处理后获得的一系列重建图像.因其简单、快速、安全、非侵入性等优点, 易于被患者接受.随着多层螺旋CT(multi-slice spiral computed tomography, MSCT)的应用和计算机软件的不断改进, CTC的图像质量和分析能力有了明显改善, CTC对1 cm以上息肉有很高的敏感性和特异性, 且在结直肠癌的准确诊断和正确的术前分期中显示了明显的优势.     

Role of preoperative CT colonography in patients with colorectal cancer

In patients with colorectal cancer(CRC),accurate preoperative evaluation is essential for a correct therapeutic plan.Colonoscopy and intravenous contrastenhanced computed tomography(CT)are currently recommended in the preoperative work-up for CRC.Preoperative colonoscopy has some limitations such as misdiagnosis of synchronous cancers in cases of incomplete exploration of the colon and inaccurate tumor localization.Intravenous contrast-enhanced CT successfully documents distant metastases although it sometimes enables unsatisfactory locoregional staging.Computed tomography colonography(CTC)is obtained after gas insufflation of the colon and offers a comprehensive preoperative evaluation in patients with CRC,including a definition of the segmental location of the tumor,presence of synchronous lesions or lack thereof,and fairly accurate locoregional staging.CTC has some limitations,including a lack of biopsy capability,suboptimal sensitivity for synchronous small polyps,and unsatisfactory nodal staging.Bearing in mind these limitations,CTC could be employed as a"one-stop-shop"examination for preoperative assessment in patients with CRC.     

Colorectal cancer screening:The role of CT colonography

Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC scre...     

Role of virtual computed tomographic colonography in patients with colorectal cancers and obstructing colorectal lesions

PURPOSE: The aim of this study was to assess the ability of computed tomographic colonography to diagnose colorectal masses, stage colorectal cancers, image the proximal colon in obstructing colorectal lesions, and evaluate the anastomoses in patients with previous colorectal surgery. METHODS: We prospectively performed computed tomographic colonography examinations in 34 patients (20 males; mean age, 64.2; range, 19–91 years): 20 patients had colorectal masses (defined at endoscopy as intraluminal masses 2 cm or larger), 7 patients had benign obstructing colorectal strictures, and 7 patients had a prior colorectal resection. Final tumor staging was available in all 16 patients who had colorectal cancers and 15 patients were referred after incomplete colonoscopy. The ability of computed tomographic colonography to stage colorectal cancers, identify synchronous lesions in patients with colorectal masses, and image the proximal colon in patients with obstructing colorectal lesions was assessed. RESULTS: Computed tomographic colonography identified all colorectal masses, but overcalled two masses in patients who were either poorly distended or poorly prepared. Computed tomographic colonography correctly staged 13 of 16 colorectal cancers (81 percent) and detected 16 of 17 (93 percent) synchronous polyps. Computed tomographic colonography overstaged two Dukes Stage A cancers and understaged one Dukes Stage C cancer. A total of 97 percent (87/90) of all colonic segments were adequately visualized at computed tomographic colonography in patients with obstructing colorectal lesions compared with 60 percent (26/42) of segments at barium enema (P<0.01). Colonic anastomoses were visualized in all nine patients, but in one patient, computed tomographic colonography could not distinguish between local tumor recurrence and surgical changes. CONCLUSION: Computed tomographic colonography can accurately identify all colorectal masses but may overcall stool as masses in poorly distended or poorly prepared colons. Computed tomographic colonography has an overall staging accuracy of 81 percent for colorectal cancer and is superior to barium enema in visualizing colonic segments proximal to obstructing colorectal lesions.Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington D.C., May 1 to 6, 1999.     

Three-dimensional MR and axial CT colonography versus conventional colonoscopy for detection of colon pathologies

AIM: To evaluate the sensitivity and specificity of MR colonography (MRC) and CT performance in detecting colon lesions, and to compare their sensitivity and specificity with that of conventional colonoscopy. METHODS: Forty-two patients suspected of having colonic lesions, because of rectal bleeding, positive fecal occult blood test results or altered bowel habits, underwent the examinations. After insertion of a rectal tube, the colon was filled with 1000-1500 mL of a mixture of 9 g/L NaCI solution, 15-20 mL of 0.5 mmol/L gadopentetate dimeglumine and 100 mL of iodinized contrast material. Once colonic distension was achieved, three-dimensional gradient-echo (3D-GRE) sequences for MR colonography and complementary MR images were taken in all cases. Immediately after MR colonography, abdominal CT images were taken by spiral CT in the axial and supine position. Then all patients were examined by conventional colonoscopy (CC). RESULTS: The sensitivity and specificity of MRC for colon pathologies were 96.4% and 100%, respectively. The percentage of correct diagnosis by MRC was 97.6%. The sensitivity and specificity of CT for colon pathologies were 92.8%, 100%, respectively. The percentage of correct diagnosis by CT was 95.2%. CONCLUSION: In detecting colon lesions, MRC achieved a diagnostic accuracy similar to CC. However, MRC is minimally invasive, with no need for sedation or analgesics during investigation. There is a lower percentage of perforation risk, and all colon segments can be evaluated due to multi-sectional imaging availability; intramural, extra-intestinal components of colonic lesions, metastasis and any additional lesions can be evaluated easily. MRC and CT colonography are new radiological techniques that promise to be highly sensitive in the detection of colorectal mass and inflammatory bowel lesions.     

CT colonography in the diagnosis and management of colorectal cancer:Emphasis on pre-and post-surgical evaluation

This article addresses the use of computed tomographic colonography(CTC)for the diagnosis and management of colorectal cancer,focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery.The key evidences accumulated in the literature and future work needed are summarized.CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer,which prevents colonoscopic examination past the occlusion,either before or after metallic stent placement.The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results.However,the accuracy of CTC for distinguishing intramural cancers from adenomas is low,and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon.A maximal diameter≥15 mm has been proposed as a criterion for surgical removal of proximal lesions.However,this needs to be verified in a larger cohort.In addition,the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined.CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC,which can serve as an effective stand-alone tool for postcancer resection surveillance of both the colorectum and extracolonic organs.Although the accuracy of CTC has been demonstrated,its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined.Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.     

激光诱发荧光与大肠癌的诊断

目的 研究激光诱发荧光（ＬＩＦ）技术在大肠癌早期诊断中的作用,并对ＬＩＦ光谱产生的机制进行初步的探讨。方法 １．以氮分子激光器作为激发光源,采用ＯＡＭⅢ对体外６０例标本及体内８３例患者病变组织与正常组织的ＬＩＦ光谱进行记录、分析。２、应用激光共聚焦扫描显微镜检测组织各层荧光强度。结果 １．根据体内,外ＬＩＦ光谱的特点,选择主峰强度、１４００ｎｍ／１５３０ｎｍ（ｘ２）和集成光强度（３５０￣６００ｎｍ     

64层螺旋CT仿真结肠镜对结直肠占位性病变的筛选价值

目的 探讨64层螺旋CT仿真结肠镜（CTC）对结直肠占位性病变的筛选价值.方法 65例疑为结肠占位的患者,经肛门注气后行64层螺旋CT腹盆腔连续薄层扫描,应用64层螺旋CT仿真结肠镜软件对获取的数据进行三维仿真结肠镜图像重建,与结肠镜和临床病理结果进行对照分析.结果 结肠镜诊断结肠息肉患者36例共56枚息肉,CTC发现32例共45枚息肉,CTC结直肠息肉检出率为86.5％;结肠镜诊断结肠癌12例,CTC诊断结肠癌15例,能够显示结肠癌的大体分型、＞5.0mm的癌结节,能直观反映癌肿处肠壁及肠周受侵状况,对癌肿肠周受侵判断准确率较高.结论 CTC对结肠占位性病变是一种无创、有效的检查方法,可成为高危人群结肠肿瘤筛选的方法之一.     

Preoperative evaluation of colorectal cancer using CT colonography,MRI, and PET/CT

Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.     

双源计算机断层扫描双能量结肠镜检测结肠肿瘤准确性的临床研究

目的：比较常规 CT 结肠镜（CTC）与双能量 CTC 检测占位性病变的准确性。方法选择临床怀疑有结肠占位性病变患者28例,均采用双能量增强 CT 扫描,并进行结肠镜重建和双能量碘图重建。比较结肠占位性病变的直径、增强后 CT 值和含碘值。以结肠镜及病理结果作为金标准,比较常规 CTC 和双能量 CTC 诊断结肠占位性病变的敏感度、特异度、准确率、阳性预测值和阴性预测值。多组间的计量资料比较采用方差分析,计数资料比较采用卡方检验。结果28例患者中,CTC 检出结肠占位性病变24例,经结肠镜及病理证实假阳性4例,假阴性1例。双能量 CTC 检出结肠占位性病变20例,经结肠镜及病理证实无假阳性患者,假阴性1例。腺瘤样息肉、腺瘤、腺癌和粪块增强后的 CT 值分别为（38．54±6．82）、（49．16±7．31）、（52．61±5．93）和（34．00±1．41）Hu,腺瘤和腺癌的强化值明显高于腺瘤样息肉和粪块,差异有统计学意义（F ＝10．760,P ＝0．001）;息肉与粪块两组间比较,差异无统计学意义（t ＝1．44,P ＝0．188）。常规 CTC 与双能量 CTC 检测占位性病变的敏感度分别为95．6％（95％CI ：77．9％～99．2％）和95．6％（95％CI ：77．9％～99．2％）,特异度分别为42．8％（95％CI ：15．4％～93．5％）和100．0％（95％CI ：47．9％～100．0％）。结论与传统的 CTC 相比,双能量 CTC 可区分粪便残渣与肿块,有助于肿瘤良恶性的鉴别,进一步提高 CTC 诊断的准确性。     

结直肠癌肝转移患者动态CT增强扫描影像学表现

目的 探讨结直肠癌患者肝内转移灶CT动态增强表现特征以及肝内分布规律。方法 2011年1月~2016年12月在我院经组织病理学检查确诊的结直肠癌伴肝转移患者94例,常规行三期增强CT检查。结果 在94例结直肠癌患者中,检出肝内转移灶389个,包括环形强化灶224个（57.6%）,结节状强化灶122个（31.4%）,其它类型强化灶43个（11.1%）; 33例右侧结肠癌患者肝内转移灶位于肝右叶者89个（69.5%）,位于肝左叶者39个（30.5%）,右叶分布比例明显高于左叶（P<0.05）;61例左侧结肠癌患者肝内转移灶位于肝右叶者137个（52.5%）,位于肝左叶者124个（47.5%）,两组肝内转移灶分布差异具有统计学差异（P<0.01）。结论 结直肠癌肝转移灶CT动态增强表现有一定的特征,其原发病灶位置与肝内转移瘤分布有一定的规律,了解这些特征有助于提高对结直肠癌肝转移癌的检出率。