摘要
目的：评估直肠癌术前ＣＴ扫描的价值。材料与方法：１０４例直肠癌（Ｔ２期１１例、Ｔ３期９０例、Ｔ４期３例）的ＣＴ扫描与手术病理对照，重点分析ＣＴ显示肿瘤边缘改变、浸润周径、淋巴结大小对Ｔ、Ｎ分期的价值。结果：以肿瘤边缘短硬毛刺、锯齿状和结节改变作为Ｔ３的诊断指标，其准确率分别为９４．０％、９０．４％、８８．４％；Ｔ分期的准确率是８９．４％，Ｔ３的准确率是９４．０％。将肿瘤侵犯肠管周径＞１／２与≤１／２作为Ｔ３期的诊断指标，有显著统计学差异（Ｐ＜０．０１）。平扫与增强扫描对Ｔ分期无统计学差异（Ｐ＞０．０５）。以５ｍｍ、８ｍｍ、１０ｍｍ作为淋巴结转移的诊断标准，其准确性分别为６８．７％、７７．２％、７６．１％，特异性分别为７２．３％、９１．２％、９２．２％，敏感性分别为６０．９％、４７．４％、４１．７％。８ｍｍ、１０ｍｍ与５ｍｍ对比，其准确性间有显著性差异（Ｐ＜０．０１）。结论：直肠癌的术前ＣＴ扫描对临床选择最佳治疗方案有重要意义。肿瘤边缘短硬毛刺、锯齿状和结节改变是Ｔ３期的可靠诊断依据，肿瘤侵犯肠管周径＞１／２周，及肿瘤边缘模糊对诊断Ｔ３期有重要参考价值。淋巴结转移的ＣＴ诊断阈以短径≥８ｍｍ为宜。
Objective: To
evaluate the preoperative CT scan of rectal carcinoma. Materials and Methods: Comparative
study was made between CT manifestations and pathologic findings in 104 cases with rectal
carcinoma (T2=11, T3=90, T4=3), focusing on the relationship between TN staging and tumor
margin, circumferential involvement, lymph node size. Results: When taking spiculate,
serrated or lobulated changing of tumor margin as criteria of T3 staging, the diagnostic
accuracy was 94.0%, 90.4% and 88.4%, respectively. The overall accuracy was 89.4% for T
staging, and 94% for T3 staging. When taking tumor invasion of the rectal wall as T3 staging
criteria, significant statistical difference ( P <0.01) was existed between group with and group
without tumor invasion exceeding half of rectal circumference. When taking the least lymph
node diameter 5mm, 8mm, 10mm as the normal upper limit, the accuracy for determing
metastasis was 68.7%, 77.2% and 76.1%, with a specificity of 72.3%, 91.2% and 92.2%, and a
sensitivity of 60.9%, 47.4% and 41.7%, respectively. Significant difference ( P <0.01) was
existed between the above three groups. No significant difference in T staging was found
between plain and enhanced CT scans ( P >0.05). Conclusion: The preoperative CT of rectal
carcinoma can demonstrate the lesion extent, which is very helpful for surgery planning.
Spiculate, serrated and lobulated margin are the most reliable signs for T3. Poorly defined
margin and greater extent of circumferential invasion are valuable findings for T3, too. The least
diameter of 8mm is recommended to serve as the upper limit of lymph node not being involved
by metastases.
出处
《临床放射学杂志》
CSCD
北大核心
1999年第4期218-221,共4页
Journal of Clinical Radiology
关键词
直肠癌
术前
CT
诊断
Rectal cancerTomography, Xray computedPreoperative
