能谱CT等渗甘露醇胃肠低张造影诊断直肠癌分期

发布时间：2018-03-22 14:22

本文选题：直肠肿瘤　切入点：体层摄影术　出处：《中国医学影像学杂志》2015年11期 　论文类型：期刊论文

【摘要】：目的探讨能谱CT成像结合口服等渗甘露醇胃肠低张造影对直肠癌术前T、N分期的诊断效能。资料与方法 47例经手术病理证实的直肠癌患者,均于CT检查前行口服等渗甘露醇溶液胃肠低张造影,并在能谱成像模式下行腹盆腔CT平扫及双期增强扫描,应用能谱分析软件获取直肠癌的最佳对比噪声比图像,评估T分期并与术后病理T分期进行对照;分别采用传统方法和能谱曲线法评估N分期并与术后病理N分期进行对照。结果① 47例患者均顺利完成检查,直肠充盈及病灶显示满意;②最佳单能量图像诊断直肠癌T分期的符合率为83.0%(39/47),与病理T分期相关性一般(Kappa=0.713,P0.001);③传统方法诊断N分期的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为78.72%、80.95%、76.92%、73.91%、83.33%,与病理N分期相关性一般(Kappa=0.574,P0.001);能谱曲线法诊断N分期的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为89.13%、75.00%、100.00%、100.00%、83.87%,与病理N分期相关性较好(Kappa=0.772,P0.001)。能谱曲线法对N分期预测的Youden指数高于传统方法(0.64比0.58)。结论口服等渗甘露醇胃肠低张造影可提供良好的直肠背景,是一种安全可靠的直肠检查方法,结合能谱CT成像可显示病灶细节和判断淋巴结的同源性,从而有助于更准确地判断直肠癌术前T、N分期。
[Abstract]:Objective to evaluate the diagnostic efficacy of energy dispersive CT imaging combined with oral hypotonic mannitol in the diagnosis of rectal cancer before operation. Methods 47 patients with rectal cancer proved by surgery and pathology were enrolled in this study. Before CT examination, hypotonic gastroenterography of isosmotic mannitol solution was taken, and plain abdominal and pelvic CT scan and dual phase enhanced scan were performed in the mode of energy spectrum imaging. The best contrast noise ratio images of rectal cancer were obtained by energy spectrum analysis software. T staging was evaluated and compared with postoperative pathological T staging, N staging was evaluated by traditional method and energy dispersive curve method, and compared with postoperative pathological N staging. Results 147 patients completed the examination successfully. The accuracy, sensitivity, specificity and positive predictive value of traditional methods for the diagnosis of N staging were 83.0% (39 / 47) and 0.71% (P 0.001), respectively. The negative predictive values were 78.72 and 76.92, respectively, and the correlation with pathological N staging was 83.330.The accuracy, sensitivity, specificity, positive predictive value of the energy spectrum curve method in the diagnosis of N staging were higher than those of Kappa (0.574) P 0.001.The negative predictive values were 73.91% and 0.574% (P 0.001), respectively. The negative predictive values were 89.135.00 and 100.000.000 and 83.87, respectively. The correlation with pathological N staging was better. The Youden index predicted by energy spectrum curve method was higher than that by traditional method (0.64 vs 0.580.Conclusion Oral isoosmotic mannitol gastrointestinal hypotonic angiography can provide a good rectal background. It is a safe and reliable method for rectal examination. Combined with energy dispersive CT imaging, it can show the details of the lesion and judge the homology of lymph nodes, which is helpful to judge the preoperative TN staging of rectal cancer more accurately.
【作者单位】：安徽医科大学附属省立医院影像科;
【分类号】：R735.37;R730.44

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