影像学检查对结肠癌手术切除可能性评估的价值

为分析结肠癌放射学诊断对手术切除可行性评估的价值，回顾性分析28例经双对比造影检查、CT扫描及手术病理证实的结肠癌患者资料。根据肿瘤的大小、范围、形态及浆膜面是否光滑、有无周围淋巴结肿大、周围器官的侵犯及远处淋巴结转移。决定能否行手术切除进行对照。结果双对比造影结合CT扫描对结肠癌手术切除可行性判断的准确率为隆起型100％、溃疡型8／8、浸润型4／8。回顾性分析结果提示，结肠双对比造影检查与CT扫描相结合，对大部分结肠癌患者术前能做出可否手术切除的可能。     

低张水灌肠螺旋CT双期增强扫描对结肠癌术前分期的应用价值

目的探讨低张水灌肠螺旋CT双期增强扫描对结肠癌术前TNM分期的准确性及临床应用价值。方法选择广东省阳春市人民医院2012年1月_2013年5月,有完整影像和病理资料的结肠癌患者62例,回顾性分析CT影像在肿瘤的部位、肠壁侵犯的深度范围、周围脂肪问隙的变化、淋巴结及远处器官转移等特点,并与手术及术后病理对照,分析低张水灌肠螺旋CT双期增强扫描对结肠癌术前TNM分期的准确性。结果低张水灌肠螺旋CT双期增强扫描对结肠癌T分期准确率90．32％（56／62）,N分期准确率80．64％（50／62）,M分期准确率100％（62／62）。结论低张水灌肠螺旋CT双期增强扫描能准确显示结肠癌的部位、确定肿瘤侵犯的深度范围、淋巴结和远处器官转移,更准确的诊断结肠癌和术前分期评估,可以作为结肠癌术前的首选检查方法。     

四种检查法对结肠癌诊断价值的评价

目的 :探讨X线、B超、结肠镜、CT对结肠癌诊断的价值。方法 :回顾性分析 5 4例经手术证实的结肠癌病例资料 ,对 4种检查法对结肠癌诊断的准确率进行比较。结果 :B超、结肠镜、结肠气钡双重造影和CT对早期结肠癌的诊断符合率分别为 2 5 0 %、90 0 %、83 3%、3 6 ,对中晚期结肠癌的诊断符合率依次为 80 9%、92 0 %、98 2 %、93 7%。结论 :早期结肠癌的诊断应以结肠气钡双重造影结合结肠镜检查为主 ;中晚期结肠癌应以钡灌肠为主 ,另选择B超或CT检查观察病变周围浸润情况及观察淋巴结、邻近脏器转移的有无 ,为选择治疗方案提供依据     

综合影像学检查对中晚期食管癌分期的意义

目的 分析X线上消化道钡剂造影、CT影像学检查对中晚期食管癌分期的意义.方法 对X线上消化道钡剂造影、CT检查并经手术病理证实的132例中晚期食管癌分期,分析病变的周围脏器侵犯及淋巴结转移情况,并与手术及病理对照.结果 CT能精确显示食管壁的厚度及与周围邻近脏器的关系,与手术对照符合率达88%,对局部淋巴结检出率与病理对照低于50%.结论 术前X线放射检查,特别是CT检查,对疗前分期、评估手术切除可能性及预后、术后CT检查对疗后再分期有重要意义.     

四种检查法对结肠癌诊断价值的评价

目的：探讨X线、B超、结肠镜、CT对结肠癌诊断的价值。方法：回顾性分析54例经手术证实的结肠癌病例资料，对4种检查法对结肠癌诊断的准确率进行比较。结果：B超、结肠镜、结肠气钡双重造影和CT对早期结肠癌的诊断符合率分别为25．0％、90．0％、83．3％、3／6，对中晚期结肠癌的诊断符合率依次为80．9％、92．0％、98．2％、93．7％。结论：早期结肠癌的诊断应以结肠气钡双重造影结合结肠镜检查为主；中晚期结肠癌应以钡灌肠为主，另选择B超或CT检查观察病变周围浸润情况及观察淋巴结、邻近脏器转移的有无，为选择治疗方案提供依据。     

术前螺旋CT检查对判断胃癌可切除性的意义

目的:探讨术前螺旋CT检查对于胃癌可切除性的意义。方法:将术前螺旋CT所显示胃壁厚度,胃周围脂肪间隙及胃周淋巴结影情况与手术中探查情况及手术切除结果进行回顾性分析。结果:在96例胃癌患者中,进行手术切除患者88例,总切除率为91.6%。当CT显示胃壁增厚,胃周脂肪间隙清晰,不论周围是否存在淋巴结影,可考虑进行手术切除。当胃周脂肪间隙消失,伴有或不伴有腹水出现时,应考虑进行新辅助化疗,根据病变缓解情况,考虑二期手术治疗。结论:术前进行螺旋CT检查对于肿瘤手术可切除性判断有重要意义。     

螺旋CT动态增强扫描及血管成像在胰腺癌术前评估中的价值

目的 探讨螺旋CT动态增强扫描及血管成像在胰腺癌术前评估中的价值.方法 45例胰腺癌患者接受螺旋CT动态增强扫描及血管成像检查,根据检查结果进行肿瘤分期和可切除性判断,并将其与术中探查结果进行对比.结果 45例患者中,27例患者接受手术治疗,其中22例术前CT评估为可切除,实际成功切除17例,阳性预测值为77%;5例术前CT评估为不可切除,手术探查均不能切除.肿瘤部位、肝脏转移和淋巴结转移方面,术前CTA评估与术中探查结果一致.结论 螺旋CT动态增强扫描及血管成像可直观显示肿瘤与周围组织结构的关系及血管受侵情况,在胰腺癌术前肿瘤分期和可切除性评估方面具有较高价值.     

术前螺旋CT检查对判断胃癌可切除性的意义

目的：探讨术前螺旋CT检查对于胃癌可切除性的意义。方法：将术前螺旋CT所显示胃壁厚度,胃周围脂肪间隙及胃周淋巴结影情况与手术中探查情况及手术切除结果进行回顾性分析。结果：在96例胃癌患者中,进行手术切除患者88例,总切除率为91.6%。当CT显示胃壁增厚,胃周脂肪间隙清晰,不论周围是否存在淋巴结影,可考虑进行手术切除。当胃周脂肪间隙消失,伴有或不伴有腹水出现时,应考虑进行新辅助化疗,根据病变缓解情况,考虑二期手术治疗。结论：术前进行螺旋CT检查对于肿瘤手术可切除性判断有重要意义。     

直径不超过2 cm周围型非小细胞肺癌的临床病理特征、手术方式及预后

背景与目的:随着CT扫描技术应用逐渐普及,对于直径不超过2 cm的周围型非小细胞肺癌(NSCLC)的检出率也逐渐提高.本研究通过对周围型小NSCLC的临床病理特征以及患者生存期的分析,试图探讨最佳的手术方式.方法:回顾性分析2000年1月-2001年7月手术切除的直径≤2 cm的周围型小肺癌75例.对手术切除方式(肺叶切除加淋巴结清扫或局部切除)、淋巴结转移情况、胸部cT影像学表现以及患者生存期与肿块大小进行比较分析.结果:接受肺叶切除加淋巴结清扫者57例,接受局部切除者18例.病灶在>1.5～≤2.0 cm者淋巴结转移率为14.63%,病灶在>1.0～≤1.5 cm者淋巴结转移率为14.81%,两组间差异无显著性(P=0.10).病灶≤1.0 cm者均未见淋巴结转移.无淋巴结转移和伴有淋巴结转移者的5年生存率分别为92.31%和60.0%(P=0.000).12例CT显示为磨玻璃影(GGO)表现者均未见有淋巴结转移,5年生存率为91.67%.结论:即使是≤2 cm的病灶仍可伴有纵隔和肺门淋巴结转移,手术切除方法宜采用肺叶切除加淋巴结清扫.但对于≤1.0 cm的病灶,尤其在高分辨CT上显示有GGO改变的病灶,可考虑行局部切除,而无需行淋巴结清扫.     

腹部CT与B超对贲门癌手术切除可能性的评估

目的　回顾性分析腹部CT与B超检查对贲门癌手术切除可能性的评估。方法　 2 2 3例贲门癌术前均行腹部CT与B超检查 ,将影像表现与手术结果对照比较。结果　贲门病变及区域淋巴结转移CT与B超诊断率分别为 90 5 %、76 2和 90 1、6 5 2 % ,两者基本相同 ;深部淋巴结转移与局部浸润CT与B超诊断率分别为 85 7%、6 2 5 %和 42 8%、37 5 % ,CT优于B超。结论　贲门癌术前行腹部CT与B超检查 ,能较客观了解贲门病变、局部浸润、淋巴结转移情况 ,尤其CT扫描提供了更直观病理与解剖学关系 ,为术前评估手术切除可能性提供了重要的参考依据。     

18F-FDGPET/CT在结直肠癌术后复发与转移诊断中的应用价值与CEA水平关系的研究

  目的   评价18F-FDG PET/CT显像对结直肠癌患者术后复发与转移的诊断价值与PET/CT检查期间CEA水平之间的关系。   方法  收集临床症状、血清CEA水平升高或CT等影像学检查怀疑复发, 并因此行PET/CT检查的结直肠癌术后患者75例, 其中男性46例, 女性29例。回顾性分析比较PET/CT显像的诊断价值在结直肠癌术后患者CEA阳性组与阴性组中的差异。   结果  PET/CT对复发与转移的检出率中CEA阳性组为89.3% (42/47), 阴性组为82.1% (23/28), 两组之间检出率差异无统计学意义(P > 0.05)。   结论  CEA水平无助于提高PET/CT对结直肠癌患者术后复发与转移的检出率, PET/CT对结直肠癌患者术后复发与转移具有较高的检出率, 是目前监测结直肠癌患者术后复发与转移较为理想的方法。      

Complete mesocolic excision: Lessons from anatomy translating to better oncologic outcome

Since the introduction of complete mesocolic excision (CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.     

Multiple hepatic metastases of colon cancer responding to combined therapy with TS-1 and CPT-11--a case report

We treated a patient with multiple liver metastases arising from colon cancer in whom the metastatic tumors were responsive to treatment with the combination of TS-1 and CPT-11. The patient was a 71-year-old woman with cancer of the ascending colon and metastatic hepatic tumors. She had undergone surgery on July 28, 2004, and abdominal contrast CT scans obtained after discharge from hospital revealed numerous LDA (low-density areas) in both lobes of the liver. The patient was given ambulatory chemotherapy with TS-1 (120 mg/day on days 1-14) and CPT-11 (100 mg/day on days 1 and 8). After completion of 2 courses of chemotherapy, abdominal contrast CT scans revealed that most of the LDAs in both lobes of the liver had disappeared, and the patient was judged to have achieved PR. No adverse reactions were observed except for a slight decrease of WBC, and her chemotherapy is being continued at present. This case suggests that the combination of TS-1 and CPT-11 may be an effective form of chemotherapy for the treatment of colon cancer with multiple hepatic metastases.     

A case of colon cancer with multiple liver metastases and lymph nodes metastases successfully treated by 5'-deoxy-5-fluorouridine

In a 79-year-old man with ascending colon cancer, multiple liver metastases were detected by computer tomography. The patient underwent right hemicolectomy. Paraaortic lymph nodes metastases were found intraoperatively. After surgery, 5'-deoxy-5-fluorouridine (5'-DFUR) was administered orally at 600 mg daily. Abdominal CT showed disappearance of the liver metastases 6 months after operation. At a follow-up exam 24 months after the beginning of the chemotherapy, the patient remained in remission and reported no side effects. We consider oral administration of 5'-DFUR to be a useful treatment for advanced colon cancer.     

多层螺旋CT对同时多原发肺癌的诊断价值

目的探讨多层螺旋CT对同时多原发肺癌的诊断价值及其误诊原因。方法回顾性分析40例83个病灶同时多原发肺癌的CT征象及组织病理类型;分析X线胸片及CT漏误诊病变原因。结果同时多原发肺癌同侧肺发病率高于双侧肺(34∶6),周围型多见,占94%。组织学类型以腺癌最多见,占79.5%(66/83),腺癌中以女性发病更多见(55.2%)。周围型病灶边缘见毛刺者占76.9%(60/78),胸膜牵拉者占70.5%(55/78)。腺癌组和非腺癌组病灶的密度(非实性结节、部分实性结节、实性结节)、结节形态(圆形或类圆形、不规则形)、边缘分叶差异有统计学意义(P值均0.05)。CT第一诊断非恶性病灶共12个,术后均为腺癌,其中4个病灶随访3～6个月后复查,病灶增大,经手术病理证实。X线胸片漏诊周围型病灶24个(22个直径≤1.5cm;12个为非实性结节),均由胸部CT扫描检出。结论同时多原发肺癌不同癌灶大多具有原发肺癌的典型CT表现,并与其病理类型有一定关系。X线胸片漏诊率高,多层螺旋CT对检出小癌灶和非实性癌灶尤为重要。初次影像表现恶性征象不典型病灶,密切随诊非常重要。     

A long term survival case of advanced colon cancer with adjacent organ involvement and multiple liver metastases

We report a long-term survival case of advanced colon cancer with adjacent organ involvement and multiple liver metastases. A 50-year-old man was admitted to our hospital because of occult bloody feces. An advanced colon cancer of the cecum was found with a colonoscopy. Histopathologically, it was a moderately differentiated adenocarcinoma with a biopsy examination. Abdominal CT showed advanced colon cancer with adjacent organ involvement and multiple liver metastases. He received right hemi-colon resection and right hepatic lobectomy. The patient was followed by 8 courses of adjuvant chemotherapy with 5-FU. He has been doing well without any recurrence for five years and six months after the operation. Usually the prognoses of Stage IV colorectal cancer patients are very unpleasant. Even thougn a few patients with Stage IV colorectal cancer can be a long-term survivor after multiple operations, we need to consider carefully the indication of the operation and QOL for a Stage IV colorectal cancer patient.     

An example of metastasis to the iliopsoas muscle from sigmoid colon cancer

Even though skeletal muscle, making up about 40% of body weight, is the largest organ in the human body, metastasis from malignant lesions is rare. Among reports of metastasis, those involving the iliopsoas muscle are numerous but few reports involve resection. Reported here is one example we experienced where metastasis developed in the iliopsoas muscle following colectomy, resection was then made possible by radiotherapy and chemotherapy. The case involved a 71-year- old male in which a Hartmann procedure was performed for sigmoid colon cancer. The pathology was Type 3 (8 × 7 cm, adenocarcinoma( mod), ss or more, ly1, v1, n0, ow(-), aw or ew(+), stage II). Upon additional sampling, thermal degredation of neoplastic cells was shown and outpatient oral UFT was performed. Five years following surgery, lymphoadenopathy was noted in the area of the left iliac artery upon US and CT. PET showed a probable metastasis to the left iliopsoas muscle. Early esophageal and stomach cancer were diagnosed by GFT. The esophageal cancer was located 30-32 cm from the incisors, unstained, Borrmann type 1, penetrating deeper than the muscularis propria. Biopsy revealed a diagnosis of tubular adenocarcinoma. ESD was performed for the esophageal cancer and one month later, a total gastrectomy D1+β was performed. During surgery, the iliopsoas muscle tumor was determined to be large and impossible to resect. Radiotherapy of 10MV X-ray, 8 fields, 65-70 Gy/26 times for 6 . 5 weeks was performed for residual tumor but had no effect on tumor size. Fifteen courses of FOLFOX+bevacizumab were then performed. The tumor was markedly reduced in size, unidentifiable upon CT but showed slight uptake on PET and resection of the suspected residual tumor was performed. Histologically, atypical cells were shown in scarred muscle and connective tissue, however, degradation by chemotherapy was high. Residual tumor at resection margins was found, findings consistent with metastasis form sigmoid colon cancer. Taking into account the age and condition of the patient following surgery, chemotherapy was changed to S-1. Currently, 5 months after resection, there has been no recurrence.     

Imaging of recurrent lung cancer.

Local, regional and distant tumor recurrence is common following surgical resection for non-small cell lung cancer. It is important to be familiar with the patterns of recurrence and to differentiate them from the normal post-operative appearance and post-radiation changes. The risks and types of recurrence are influenced by various factors including preoperative tumor stage, histological type and type of surgical resection. Treated patients are at risk for developing a second lung primary, reported to be 1-4% per year, and therefore follow-up must be aimed at detecting not only recurrent cancer, but also a new, primary lung cancer. Different follow-up imaging strategies have been suggested, including conventional radiography, CT and/or PET scanning.     

Recent progress in the x-ray diagnosis of colorectal cancer

Double contrast method is very important for the early detection of the colorectal cancer. Early cancer is divided into four types macroscopically, that is I p, I s, II a and II c. Type II c is very rare. Therefore, almost all early colorectal cancer cases are the sessile and flat elevated lesions. Most important point in the diagnosis of the early cancer is the diagnosis of the depth invasion of the cancer. The lateral view of the cancer in the X-ray images are very useful for the diagnosis of the cancer invasion. By the way, a new radiographic method has been developed in Japan recently, that is computed radiography (CR). Very clear double contrast images can be obtained by the new method with the low dosages of X-ray. For example, even the dosages are one-third or one-fourth of the conventional method, also X-ray images are very clear. Therefore, the new method will be useful for mass screening of the colorectal cancer. Furthermore, computed tomography (CT) is very useful for the diagnosis of the colorectal cancer, especially concerning to depth invasion of the cancer, permeation into the neighboring organs, and lymph node metastasis.