CT仿真内镜在低位直肠癌术前分期中的价值

目的探讨CT仿真内镜(CT virtual endoscopy,CTVE)在低位直肠癌术前分期中的价值。方法收集我院2008年8月1日至2011年3月1日期间的直肠癌患者57例,术前行直肠CTVE检查,详细记录患者直肠癌周围组织浸润和淋巴结转移的情况;患者术后常规进行病理检查,比较两者结果的差异。结果术前直肠CTVE检查与术后石蜡病理检查对直肠癌周围淋巴结转移的判断经四格表χ2检验,差异无统计学意义(χ2=2.5,P>0.05),其对直肠癌周围淋巴结转移预测的敏感性为66.67%,特异性为93.94%。术前直肠CTVE预测直肠癌周围组织浸润和术后病理检查结果经四格表χ2检验,差异有统计学意义(χ2=4.4,P<0.05),其对直肠癌周围组织浸润判断的敏感性为27.78%,特异性为42.86%。结论 CTVE在术前评估直肠癌周围淋巴结转移有较高的可信性,但对直肠癌周围组织浸润的评价较差。     

MSCT在胃癌术前分期诊断中的应用价值

探讨64层螺旋旋CT(MSCT)诊断胃癌术前分期的应用价值。选取2014年1月—2018年5月收治的287例胃癌患者,分析术前MSCT检查情况与术后病理结果差异。MSCT术前T分期与病理结果一致性好(Kappa=0.727,P<0.05);MSCT术前判断T3和T4准确度分别为89.74%和85.71%,明显高于T₁和T₂(P<0.05);MSCT术前N分期与病理结果一致性好(Kappa=0.692,P<0.05);MSCT术前判断N₀、N₁和N₂的准确度分别为83.97%、75.29%和78.87%,差异无统计学意义(P<0.05);MSCT术前M分期与病理结果一致性极佳(Kappa=0.888,P<0.05);MSCT术前判断M0和M1的准确率分别为96.77%和92.86%,差异无统计学意义(P>0.05)。64层螺旋旋CT能较准确地判断胃癌分期情况,为治疗方案的制定提供依据。     

乙酰肝素酶2蛋白的表达与胰腺癌浸润、转移的关系及其意义

为探讨乙酰肝素酶2（Hpa2）蛋白与胰腺癌浸润、转移的关系及其临床病理意义，笔者应用免疫组织化学染色法检测26例胰腺癌组织中Hpa2蛋白的表达和微血管密度（MVD）。结果示Hpa2蛋白在正常胰腺组织中不表达，而在胰腺癌组织中的阳性率为69.23%（18/26），在癌旁组织中阳性率为33.33%（7/21），两者差异有显著性（P<0.05）。癌组织MVD为19.47±5.14，癌旁组织MVD为14.17±5.84，差异亦有显著性（P<0.05）。胰腺癌组织中Hpa2蛋白的表达和MVD分别与患者的年龄、性别、肿瘤直径无关（P>0.05），但与肿瘤的临床分期、包膜是否完整、是否有淋巴结转移有关（P<0.05）。Hpa2表达阳性组的MVD［（20.84±4.99）/HP］高于Hpa2表达阴性组MVD［（16.39±4.26）/HP］（P<0.05）。提示Hpa2蛋白可能参与胰腺癌的发生和发展过程，对判断胰腺癌的浸润、转移有一定的参考价值。     

盆腔增强CT和MRI在局部复发直肠癌多器官联合切除中应用价值研究

目的 探讨盆腔增强CT和MRI在局部复发直肠癌（LRRC）多器官联合切除中的价值。方法 回顾性分析2012 年 1 月至 2018 年 12 月复旦大学附属华山医院外科收治的行手术治疗的48 例LRRC病人的临床资料，病理组织保存完整。LRRC根据纪念斯隆-凯特琳癌症中心（MSKCC）标准分为中央型、前向型、后向型和侧向型。术前均行腹部增强CT和盆腔平扫+增强MRI检查。比较CT和MRI对LRRC术前诊断准确率、对邻近器官侵犯的预测价值，并分析二者融合图像对手术的指导作用。结果 48例病人中41例（85.4%）经术后病理学检查确诊直肠癌术后复发。MRI和CT对LRRC检出率分别为95.1%（39/41）和87.8%（36/41），差异无统计学意义（χ2=1.406，P=0.236），MRI诊断LRRC的准确率高于CT［91.7%（44/48） vs. 77.1%（37/48），χ2=3.872，P=0.049］。盆腔增强CT及MRI鉴别LRRC累及邻近器官的准确率分别为70.8%（34/48）和 68.7%（33/48），差异无统计学意义（χ2=0.049，P=0.824）。各 LRRC 亚型分析提示，增强CT的鉴别准确率：后向型100%（7/7）、侧向型71.4%（5/7）、中央型69.6%（16/23）、前向型54.6%（6/11）；盆腔增强MRI的鉴别准确率：中央型78.3%（18/23）、前向型63.6%（7/11）、后向型57.1%（4/7）和侧向型57.1%（4/7）。所有病人均顺利完成手术，R0切除率为 85.4%（41/48）。结论 推荐增强MRI检查作为 LRRC诊断辅助手段；增强CT对后向型LRRC骶尾骨侵犯检出率高，而增强MRI判断中央型LRRC准确率较高；多模态融合图像有助于确定LRRC手术切除范围并制定策略。     

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。     

腔内超声与螺旋CT对直肠癌术前分期的对比研究

目的比较腔内超声（EUS）和螺旋CT（SCT）对直肠癌术前分期的诊断价值。方法对68例直肠癌患者术前行EUS和SCT检查，将检查结果与手术及病理结果对比；同时比较EUS和SCT对诊断直肠肿瘤浸润深度、区域淋巴结转移的准确性。结果判断T分期，EUS准确率为86．8％（59／68），SCT准确率为70．6％（48／68），两者比较差异有统计学意义（P〈0．05）。评价N分期，EUS的准确率为67．6％（46／68），SCT的准确率为63．2％（43／68），两者比较差异无统计学意义（P〉0．05）。结论EUS对判断直肠肿瘤浸润深度优于SCT，但两者对淋巴结转移的判断均存在一定的局限性。     

FASN在直肠癌患者外周血中的表达变化及意义

目的：探讨脂肪酸合成酶（FASN）在直肠癌患者外周血中的表达变化及意义。 方法：选取经病理活检诊断为直肠癌的患者42例，其中28例行直肠癌根治术(根治组)，14例行直肠癌姑息术（姑息组），选取正常人16例（对照组）；分别应用ELISA方法检测正常人及直肠癌患者手术前后外周血中FASN的浓度。 结果：术前直肠癌患者外周血FASN水平明显高于对照组（P<0.05）；根治组术后患者血FASN低于术前（P<0.05)，与对照组比较无统计学差异（P>0.05），姑息组术后血FASN水平与术前比较无统计学差异（P>0.05），且高于对照组和根治组术后患者（P<0.05）；Logistic回归分析表明：癌胚抗原（CEA）、FASN、C反应蛋白 （CRP）、便秘史是直肠癌的危险因素（P<0.05）。 结论：FASN在直肠癌患者外周血中表达增高，术后患者血FASN水平降低，测定FASN在外周血的表达可能成为早期诊断恶性肿瘤及判断预后的一个重要指标。     

CT和MRI对直肠癌术前T、N分期的对比研究

目的比较螺旋CT与磁共振成像(MRI)对直肠癌术前T、N分期判断的价值。方法回顾性分析2013年1月至2017年1月期间合肥市第二人民医院普外科收治并行手术治疗的81例直肠癌患者的影像学资料,81例患者均行了CT检查,其中63例患者同时行了MRI检查,以术后病理检查结果为金标准,比较CT和MRI对判断直肠癌T分期和N分期的准确性。结果 CT和MRI判断直肠癌术前T分期的灵敏度分别为69.1%(56/81)和82.5%(52/63),二者比较差异无统计学意义(χ~2=3.396,P=0.065);其Kappa值分别为0.521和0.720,提示CT判断T分期与病理诊断一致性一般而MRI判断T分期与病理诊断一致性较好。CT判断T1-2、T3及T4期的灵敏度分别为70.0%、66.7%和72.0%,MRI判断T1-2、T3及T4期的灵敏度分别为83.3%、83.3%和81.0%,二者分别比较差异均无统计学意义(P0.05)。CT和MRI判断T1-2、T3和T4期的受试者操作特征曲线下面积分别为0.809、0.689和0.798以及0.897、0.826和0.869。CT和MRI判断直肠癌术前N分期的灵敏度分别为59.3%(48/81)和65.1%(41/63),二者比较差异无统计学意义(χ~2=0.509,P=0.476);其Kappa值分别为0.371和0.463,CT和MRI判断N分期与病理诊断一致性均一般。CT判断N0、N1和N2期的灵敏度分别为64.7%、45.5%和64.0%,MRI判断N0、N1和N2期的灵敏度分别为70.3%、63.2%和72.5%,二者分别比较差异均无统计学意义(P0.05)。结论 MRI判断直肠癌肿瘤浸润深度优于CT,二者对淋巴结转移的判断准确度均不高。     

结直肠充气螺旋 CT对结直肠癌术前分期的诊断价值

目的探讨结直肠充气螺旋CT扫描对结直肠癌术前分期的诊断价值。方法从1998年8月至2002年12月,对术前64例经结肠镜活检证实的结直肠癌患者进行结直肠充气,然后行螺旋CT扫描,采用Dukes分期法,将螺旋CT分期结果与手术和病理结果对照。结果结直肠充气螺旋CT图像能清晰地显示全部结直肠肿块,对浆膜层浸润的敏感性为95.2%(40/42),特异性为40.9%(9/22),准确性为76.6%(49/64);判断淋巴结有无转移的敏感性为75.0%(15/20),特异性为90.9%(40/44),准确性为85.9%(55/64);总的分期准确性为64.1%。结论结直肠充气螺旋CT对结直肠癌术前分期有一定的诊断价值和局限性。     

盆腔增强CT和MRI在局部复发直肠癌多器官联合切除中应用价值研究

目的 探讨盆腔增强CT和MRI在局部复发直肠癌（LRRC）多器官联合切除中的价值。方法 回顾性分析2012 年 1 月至 2018 年 12 月复旦大学附属华山医院外科收治的行手术治疗的48 例LRRC病人的临床资料,病理组织保存完整。LRRC根据纪念斯隆-凯特琳癌症中心（MSKCC）标准分为中央型、前向型、后向型和侧向型。术前均行腹部增强CT和盆腔平扫+增强MRI检查。比较CT和MRI对LRRC术前诊断准确率、对邻近器官侵犯的预测价值,并分析二者融合图像对手术的指导作用。结果 48例病人中41例（85.4%）经术后病理学检查确诊直肠癌术后复发。MRI和CT对LRRC检出率分别为95.1%（39/41）和87.8%（36/41）,差异无统计学意义（χ2=1.406,P=0.236）,MRI诊断LRRC的准确率高于CT［91.7%（44/48） vs. 77.1%（37/48）,χ2=3.872,P=0.049］。盆腔增强CT及MRI鉴别LRRC累及邻近器官的准确率分别为70.8%（34/48）和 68.7%（33/48）,差异无统计学意义（χ2=0.049,P=0.824）。各 LRRC 亚型分析提示,增强CT的鉴别准确率：后向型100%（7/7）、侧向型71.4%（5/7）、中央型69.6%（16/23）、前向型54.6%（6/11）;盆腔增强MRI的鉴别准确率：中央型78.3%（18/23）、前向型63.6%（7/11）、后向型57.1%（4/7）和侧向型57.1%（4/7）。所有病人均顺利完成手术,R0切除率为 85.4%（41/48）。结论 推荐增强MRI检查作为 LRRC诊断辅助手段;增强CT对后向型LRRC骶尾骨侵犯检出率高,而增强MRI判断中央型LRRC准确率较高;多模态融合图像有助于确定LRRC手术切除范围并制定策略。     

Preoperative staging of rectal cancer: pelvic MRI plus abdomen and pelvic CT. Does extrahepatic abdomen imaging matter? A case for routine thoracic CT

Objective To assess the quality of preoperative magnetic resonance imaging (MRI) staging of rectal cancer, and the clinical significance of abdomen and pelvic computed tomogram (CT) scans in preoperative staging of rectal cancer in a district general hospital. We postulated that the ‘metastatic yield’ of extrahepatic abdominal imaging is poor, and rarely altered management of rectal cancer. Methods This is a retrospective study of preoperative MRI, CT scans and postoperative histology results of patients who had definitive surgery for rectal cancer at the Mid‐Staffordshire General Hospitals NHS Trust over a 36‐month period. Preoperative multiplanar pelvic MRI locoregional staging was compared with eventual histology. The incidence of and significance of abdomen and pelvic CT detected pathology (including metastasis) in the management of rectal cancers was also assessed. Results Preoperative pelvic MRI correctly predicted ‘clear’ Circumferential resection margins, in 28 of 29 patients who had primary surgery. This is comparable with many published studies. Significant CT detected pathology (including metastasis) on preoperative abdomen and pelvic CT scans was uncommon, and did not influence management of any rectal cancer patient in our study. Discussion Given that exclusive CT detected significant pathology caudal to the liver (extrahepatic abdomen) is rare, can full abdomen and pelvic CT scans be justified for preoperative staging of rectal cancers? – especially where chest X rays are employed for lung staging. Preoperative thoracic and upper abdomen CT scan may be a more productive use of resources. Full abdominal scans may be more appropriate for selection of rectal cancer patients with isolated liver metastasis for metastasectomy.     

The clinical value of preoperative staging of bladder and prostatic cancers with nuclear magnetic resonance and computerized tomography

To evaluate the diagnostic value of preoperative staging of bladder cancer and cancer of the prostate, CT and NMR scans of 45 histologically defined tumors of the bladder and the scans of 24 patients with radical prostatectomy were compared. Lack of extravesical spread was imaged correctly by NMR in all cases of urothelial cancer (pT1-pT3a). CT diagnosis failed in 39%. False-negative results were obtained in 2 of 5 invading tumors (pT3b) by NMR and in 3 of 5 by CT. Extraglandular spread of cancer of the prostate was diagnosed with an accuracy rate of 79% by NMR and of 46% by CT. The diagnostic value for detection of pelvic lymph node metastases had a low-sensitivity rate of 26% in NMR and of 22% in CT.     

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??Significance of inflatable rectal CT in the diagnosis and clinical staging of rectal cancer LI Wei, LIU Ke-sheng??CUI Gen. Department of General Surgery, Jiaonan Economic and Technological Development Zone Hospital,Jiaonan 266400,China Corresponding author: LI Wei?? E-mail: Liwei_750518@163.com Abstract Objective To evaluate the significance of inflatable rectal CT in the diagnosis and clinical staging of rectal cancer??Methods Inflatable rectal CT of 54 cases of rectal cancer confirmed by surgery pathology between May 207 and July 2009 at Jiaonan Economic and Technological Development Zone Hospital were investigated retrospectively. It evaluated the significance of inflatable rectal CT in the diagnosis and clinical staging of rectal cancer??Results Full expansion of the rectum and sigmoid colon, rectum wrapping around the fat density of the structure of the intestinal wall and the relatively high density and very low density contrast mesocaval were showed clearly in patients with the inflatable rectal CT. The overall accuracy rate of rectal cancer TNM staging was 85.2%??46/54??. The accuracy of T, N and M was 90.7%(49/54??, 87.0% (47/54)and 98.1%(53/54) respectively. Conclusion Inflatable rectal CT can show the size, shape, depth of invasion, lymph node metastasis, the relationship with the surrounding organs and distant metastasis clearly. Imaging features of the mesorectum were clear. Inflatable rectal CT had a higher consistency with TNM staging.It was an important method for the preoperative diagnosis and clinical staging of rectal cancer.     

MRI在直肠癌术前分期中的作用

目的:评估盆腔MRI检查在直肠癌术前分期和治疗决策中的作用。方法:对2009年4月至2010年6月手术治疗的60例直肠癌病例的术前盆腔MRI检查结果与术后组织病理学诊断结果进行比较,分析MRI对直肠癌术前分期的准确率。结果:MRI对直肠癌浸润深度(T分期)的诊断准确率为75%,对T2期肿瘤的诊断准确率为73.1%,对T3期肿瘤的诊断准确率为86.7%;对淋巴结转移的诊断准确率为32.4%。在病理确诊淋巴结转移的16例病人中,MRI检出淋巴结平均数为5.8枚;在淋巴结转移阴性的44例病人中,MRI检出淋巴结平均数为2.4枚;两组淋巴结数有显著差异(P0.05)。结论:术前MRI检查可较准确地判断肿瘤在直肠壁的浸润深度,但对淋巴转移的诊断准确率较低,故MRI可作为直肠癌术前分期的方法,为新辅助治疗提供依据,为术后辅助化疗提供信息。     

经直肠三维超声联合双平面超声在直肠癌术前分期中的临床应用价值分析

目的探讨经直肠三维超声与双平面超声联合应用对直肠癌术前分期的临床意义。方法 76例直肠癌患者采用经直肠三维超声联合双平面超声检查,与术后分期诊断结果进行对比,计算单纯经直肠三维超声及经直肠三维超声联合双平面超声对直肠癌术前分期诊断的准确率,并进行对比分析。结果联合应用经直肠三维超声与双平面超声检查对直肠癌术前分期的准确率为93.4%(71/76),显著高于单纯经直肠三维超声检查的82.9%(63/76),P0.05。结论经直肠三维超声与双平面超声联合应用于直肠癌的术前分期诊断,准确性较高,对于手术方案的制定以及患者预后均具有重要意义。     

A comparison between intrarectal ultrasound and CT scanning in staging of experimental rectal tumors

The purpose of this study was to compare the accuracy of preoperative staging of experimental rectal tumors by digital rectal exam, intrarectal ultrasound (IRUS), and CT scanning with pathologic exam. Rectal tumor masses were induced in 10 mongrel dogs by submucosal injection of 2-3 cc of Freund's complete adjuvant. One week later, the animals underwent digital rectal exam, IRUS, and pelvic CT scans. Pelvic exenteration specimens were submitted for pathologic evaluation. Evaluations and interpretations were done in blinded fashion by independent examiners. The rectal "tumor" was detected in 9 of 10 digital exams, 10 of 10 IRUS exams, and 1 of 10 CT scans. Correct Duke's staging occurred in 70% of digital exams, 90% of IRUS exams, and 10% of CT exams compared to pathological staging. Lymph nodes were detected on pathologic exam in all animals (8.7/animal, range 3-16), on IRUS in all animals (6.4/animal, range 5-13), and in none of the digital or CT examinations. IRUS was significantly more accurate in detecting (P less than 0.0001) and locally staging tumors (P less than 0.0001), and in detecting and localizing lymphadenopathy compared to CT scan. Intrarectal ultrasound is a simple, highly accurate device for assessing depth of wall penetration of rectal tumors and in detecting pararectal lymph nodes and should be considered the preoperative staging procedure of choice for rectal cancer.     

Preoperative evaluation of pelvic lateral lymph node of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients

Background Preoperative assessment of the lateral pelvic lymph nodes is important for treatment strategy to patients with lower rectal cancer.Materials and methods Fifty-three patients with primary lower rectal cancer were preoperatively assessed by spiral computed tomography (CT) and magnetic resonance imaging (MRI) at 1.5 T with a phased-array coil. Preoperative tumor and lymph node stages were compared with the final histological findings.Results The MRI tumor stage coincided with the histological stage in 36 of 53 patients (68%). The MRI and CT lymph node stage coincided with the histological stage in 33 (62%) and 26 (49%) of 53 patients, respectively. However the accuracy of MRI in detecting the lateral pelvic lymph node involvement was 83%, compared to 77% of CT (p<0.05).Conclusions With the use of MRI, the lateral pelvic lymph node involvement can be predicted with high accuracy, allowing preoperative identification of patients who need radiotherapy or extensive surgery to escape recurrence.     

The Potential of Restaging in the Prediction of Pathologic Response After Preoperative Chemoradiotherapy for Rectal Cancer

BACKGROUND: We performed this study to prospectively evaluate the postchemoradiotherapy performance of transrectal ultrasonography (TRUS), pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI), and endoscopic biopsies for predicting the pathologic complete response of rectal cancer patients. METHODS: Four weeks after completion of preoperative chemoradiotherapy, 46 consecutive patients with mid to low rectal cancer were prospectively evaluated by proctoscopy, TRUS, and pelvic CT scan and MRI. On the basis of T and N status, patients were classified as T0 or T1-4 and N-negative or N-positive. For each staging modality used, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Findings were compared with the pathologic tumor-node-metastasis stage. RESULTS: On histopathologic analysis, 12 patients had pT0 and 34 had pT1-4 lesions; out of 45 assessable patients, 9 were N-positive. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting T status (T0 vs. T >or=1) were 77%, 33%, 74%, 36%, and 64%, respectively, for TRUS; 100%, 0%, 74%, not assessable, and 74% for CT; and 100%, 0%, 77%, not assessable, and 77% for MRI. The corresponding figures in predicting N status (N-negative vs. N-positive) were, respectively, 37%, 67%, 21%, 81%, and 61% for TRUS; 78%, 58%, 32%, 91%, and 62% for CT; and 33%, 74%, 25%, 81%, and 65% for MRI. CONCLUSIONS: Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.     

螺旋CT仿真内窥镜技术在膀胱肿瘤分期诊断中的应用

目的 探讨螺旋CT仿真内窥镜(CTVE)对膀胱肿瘤分期诊断的作用。方法 对10例正常对照和40例经手术病理检查证实的膀胱肿瘤患者术前采用多层面螺旋CT机进行容积扫描,将所得扫描数据转入工作站利用三维重建检查软件进行后处理,获得膀胱CTVE三维图像。将重建图像分别与冠状或轴位CT扫描、膀胱镜检查所见、手术中所见及病理检查结果进行比较分析。结果 CTVE对膀胱肿瘤检出率及分期准确率分别为98％(39／40)和85％(33／39),直径≥0．5cm的肿瘤显示率为100%。可观察尿道内口及膀胱颈部病变,弥补膀胱镜视野盲区,但不能显示膀胱黏膜的表浅病变及进行活检。结论 CTVE具有无创优点,在膀胱肿瘤临床分期及膀胱镜视野盲区的肿瘤诊断方面是膀胱镜较好的替代和补充方法。