结肠癌的多层螺旋CT表现与临床病理对照研究

目的：探讨结肠癌的多层螺旋CT（MSCT）表现,并与病理进行对照。方法：回顾分析56例经手术病理证实的结肠癌患者的MSCT表现,并与术后病理对照,分析MSCT术前分期的准确性。结果：①56例患者CT显示肠壁增厚,45例表现为肿块或结节;②25例分化较好的肿瘤呈轻-中度均匀强化,31例分化差的肿瘤呈不均匀强化或分层状强化;③MSCT显示结肠浆膜或/和周围脂肪间隙受侵的敏感度为95.83%,特异度为87.5%,准确度为94.64%,阳性预测值97.87%,阴性预测值77.78%;④MSCT诊断淋巴结转移的敏感度为91.67%,特异度为77.42%,准确度为82.14%,阳性预测值75.86%,阴性预测值88.89%;⑤MSCT术前T分期和N分期与术后病理分期的一致性较好（KT=0.864,P=0.000;KN=0.650,P=0.000）。结论：螺旋CT扫描可有效显示结肠癌的部位、大小和形态,确定肿瘤侵犯范围、有无淋巴结及远处转移等,可以准确进行术前分期,具有较高的临床应用价值。

Colonic Cancer:Multi-slice Spiral CT Findings and Their Role in Preoperative Staging

Objective：To investigate the multi-slice spiral CT（MSCT） findings and their role in preoperative staging of colonic carcinoma. Methods： MSCT findings of 56 patients with colonic carcinoma confirmed by surgery and pathology were analyzed retrospectively. Furthermore,accuracy of MSCT for staging tumors preoperatively was assessed by comparison with surgical and pathologic findings. Results：①Thickening wall of colon was shown in all 56 cases,massive or nodular changes in 45 cases. ②Well-differentiated tumors of 25 cases manifested as slightly-moderately homogeneous enhancement, and poor-differentiated tumors of 31 cases as inhomogeneous or layer-like enhancement. ③Among 47 cases with serosa infil- tration and adjacent fat tissue extension revealed on MSCT images,46 were confirmed by surgery and pathology. The sensitivity, specificity,and accuracy of MSCT for evaluating serosa and adjacent fat tissue invasion were 95.83 %, 87. 5 % and 94.64 %, respectively. ④MSCT accurately diagnosed lymph nodes metastases in 22 cases which showed inhomogeneous en- hancement,or central low-density （〈60HU） and peripheral high-density,and ill-defined margin,and missed in 10 cases. The sensitivity of MSCT for revealing lymph node metastases was 91.67%, specificity 77.42% ,and accuracy 82.14%. ⑤ MSCT preoperative T and N staging had good consistency with postoperative pathologic staging （KT = 0. 864, P = 0. 000 ; KN = 0. 650, P = 0. 000）. Conclusions： MSCT is one of the optimal imaging methods in depicting tumor location, size, and morphology, delineating tumor extension, revealing lymph nodes and metastases, and making preoperative tumor staging in patients with colonic carcinoma.