64排螺旋CT在大肠腺瘤分型及癌变中的诊断价值

发布时间：2018-04-18 09:53

本文选题：肠肿瘤 + 腺瘤　；参考：《中国医学影像学杂志》2015年05期

【摘要】：目的分析不同病理类型的大肠腺瘤的CT表现,探讨64排螺旋CT在大肠腺瘤分型及癌变中的诊断价值。资料与方法回顾性分析经手术病理证实的68例结直肠腺瘤患者的CT表现,包括病变的部位、大小、形态、与邻近结构的关系及增强扫描动脉期、静脉期、延迟期的强化程度,比较不同病理类型及分级的腺瘤增强扫描动脉期、静脉期、延迟期的CT差值(△CT值)。结果 68例中,绒毛状腺瘤16例,绒毛管状腺瘤42例,管状腺瘤10例。绒毛状腺瘤及绒毛管状腺瘤表现为宽基底、绒毛状,动脉期呈脑回状或树叶状强化,表面可见一层低密度黏液覆盖;管状腺瘤表现为窄基底、结节状,均匀强化。绒毛状腺瘤与管状腺瘤各期△CT值差异有统计学意义(t动脉期=2.56,P0.05;t静脉期=3.22,P0.05;t延迟期=2.48,P0.05),绒毛状腺瘤与绒毛管状腺瘤、绒毛管状腺瘤与管状腺瘤各期△CT值差异无统计学意义(P0.05)。癌变组病灶沿肠壁匍匐性生长、周围有肠系膜血管集群或淋巴结增大。无异型增生组与癌变组各期△CT值差异有统计学意义(t动脉期=2.49,P0.05;t静脉期=2.69,P0.05;t延迟期=2.75,P0.05),无异型增生组与异型增生组、异型增生组与癌变组各期△CT值差异无统计学意义(P0.05)。动脉期△CT值以50 HU为标准鉴别非癌变与癌变的敏感度、特异度分别为76.92%、70.91%。结论不同病理类型的大肠腺瘤及其癌变的CT表现具有一定的特征性,病灶的大小、形态、增强△CT值及病灶邻近情况对术前明确诊断及治疗具有重要价值。
[Abstract]:Objective to analyze the CT findings of colorectal adenomas with different pathological types and to explore the diagnostic value of 64-slice spiral CT in the classification and carcinogenesis of colorectal adenomas.Materials and methods CT findings of 68 patients with colorectal adenoma confirmed by surgery and pathology were retrospectively analyzed, including location, size, morphology, relationship with adjacent structures, enhancement of enhanced arterial phase, venous phase, and delayed phase.The difference of CT value (CT value) in arterial phase, venous phase and delayed phase of adenoma with different pathological types and grade was compared.Results among 68 cases, 16 cases were villous adenoma, 42 cases villous tubular adenoma and 10 cases tubular adenoma.Villous adenoma and villous tubular adenoma showed broad basal, villous, cerebral gyrus or foliar enhancement in arterial phase, and a low density mucus covering on the surface, while tubular adenoma showed narrow basal, nodular and homogeneous enhancement.There was significant difference in CT value between villous adenoma and tubular adenoma in each stage. There was no significant difference in CT value between villous adenoma and villous tubular adenoma, villous tubular adenoma and tubular adenoma.In the cancerous group, the lesions were creeping along the intestinal wall with mesenteric vessels clustered or lymph nodes enlarged.There was significant difference in CT value between non-dysplasia group and cancerous group. There was no significant difference in CT value between non-dysplasia group and abnormal hyperplasia group, and there was no significant difference in CT value between dysplasia group and abnormal hyperplasia group and cancerous hyperplasia group.The sensitivity of CT value of arterial phase in distinguishing non-canceration from canceration was 76.922 ~ 70.91 according to 50 Hu standard.Conclusion CT findings of colorectal adenoma and its canceration of different pathological types have some characteristics. The size, morphology, enhanced CT value and adjacent condition of the lesions are of great value in the diagnosis and treatment of colorectal adenoma before operation.
【作者单位】：苏州大学附属第二医院影像科;
【分类号】：R735.34;R730.44

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