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目的:评价多层螺旋CT(MSCT)在直肠癌术前分期的准确性及应用价值。方法:对49例经肠镜病理证实的直肠癌患者,进行术前MSCT平扫及动态增强扫描,参考TNM分期方法进行MSCT分期,并与术后病理分期对照分析比较其敏感性等指标。结果:正常直肠壁的CT值为30～50Hu,直肠壁分层显示不明显,原发癌灶显示良好,其CT值较正常直肠壁低,T分期总敏感性为66.56%,T3、T4敏感性大于T1、T2,达90%以上,假阴性率小于10%;淋巴结的CT值为15～30Hu,增强后可提高10～20Hu,N分期的总敏感率为86.7%,对紧靠癌肿旁的淋巴结、非连续性转移、直肠系膜中的小结节敏感性低;对肝脏、阴道壁、膀胱壁、卵巢中的转移灶较敏感,对小肠、结肠及其系膜上、腹壁上的小转移灶敏感性低。结论:MSCT对T3、T4期癌原发灶显示良好,这正符合新辅助性化疗术前分期的要求,是非常实用的检查方法,应作为直肠癌术前影像学分期的常规评估手段;通过对淋巴结的大小、密度、形态及增强情况可大致判定其转移性;但对于小肠、结肠及其系膜中、腹壁上的微小转移敏感性低,分辨病变的性质有一定困难,尚需结合其他方法进行综合判定。
Objective: To evaluate the accuracy and application value of multislice spiral CT (MSCT) in preoperative staging of rectal cancer. METHODS: Forty-nine patients with rectal cancer confirmed by colonoscopy were preoperatively scanned with MSCT and dynamically enhanced. MSCT staging was performed with reference to the TNM staging method. The sensitivity and other indicators were compared with postoperative pathological staging. Results: The CT value of the normal rectal wall was 30-50 Hu. The rectal wall stratification showed no obvious. The primary foci showed good results. The CT value was lower than the normal rectal wall. The total sensitivity of the T stage was 66.56%, and the T3 and T4 sensitivity. More than T1, T2, more than 90%, false negative rate less than 10%; lymph node CT value of 15 ~ 30Hu, increased after the increase of 10 ~ 20Hu, N stage of the total sensitivity rate of 86.7%, close to the cancer Adjacent lymph nodes, non-continuous metastases, small nodules in the mesorectum are less sensitive; more sensitive to metastases in the liver, vaginal wall, bladder wall, and ovary; on the small intestine, colon and mesangial, abdominal wall Small metastases have low sensitivity. Conclusions: MSCT shows good T3 and T4 primary tumors, which is in line with the requirements of neoadjuvant chemotherapy before surgery. It is a very practical method and should be used as a routine assessment method for preoperative imaging staging of rectal cancer; The size, density, morphology, and enhancement of lymph nodes can be roughly judged for metastasis; however, the sensitivity to small metastases in the small intestine, colon, and mesenterium, and the abdominal wall is low, and the nature of distinguishing the lesions is difficult. Method for comprehensive determination.