多层螺旋CT在结肠肿瘤诊断中的应用研究

发布时间：2018-06-07 00:04

本文选题：结肠肿瘤 + 多层螺旋CT　；参考：《大连医科大学》2012年硕士论文

【摘要】：目的：结肠癌是胃肠道中常见的恶性肿瘤，，如何做到准确定性诊断和分期是选择最佳治疗方案的基础。目前，国内结肠肿瘤检查和诊断以内视镜、X线造影检查为主，结肠镜因具有影像直观、可进行活检及有病理结果等优点而应用广泛，X线造影有操作简便、影像清晰、费用低廉等优点成为结肠肿瘤的筛选手段，而这两种方法对于结肠癌的肠壁增厚程度、肠壁周围浸润、淋巴结转移及远端脏器转移均有局限性。多层螺旋CT（Multi-slice CT MSCT）扫描具有创伤小，速度快，图像清晰，可以多方位显示病变的优点，在临床上的应用比较广泛。MSCT可以结合轴位及多平面重组图像，CT仿真内视镜(CT virtual endoscopy)技术，能有效地显示肿瘤的大小、形态和部位，确定肿瘤的侵犯范围、淋巴结转移和远端脏器转移等。MSCT在结肠肿瘤的诊断中具有重要的指导作用。本项研究是探讨应用MSCT在结肠肿瘤检查中的诊断价值。目的：探讨MSCT在结肠肿瘤诊断的应用价值。方法：本文收集了2009年10月至2011年5月来大连医科大学附属二院普外科就诊的45例结肠癌患者进行腹部MSCT检查，检查前准备与结肠镜检查前肠道准备相同，检查当日禁食水，造影剂过敏试验，检查前10分钟肌注低张药物，扫描前向结肠内注入空气，常规行腹腔普通扫描及增强扫描，将得到的图像由2位主治医师以上职称的影像诊断医师共同阅片，对病灶位置，形态、大小、肠壁增厚程度、病变周围浸润，有无淋巴结（数目、大小、位置及强化程度）及有无远处转移等进行诊断，做出定性诊断及分期。统计学分析：采用SPSS13.0软件进行统计学分析，病变CT值的变化采用重复测量计数方差分析，计数资料组间比较采用x2检验（Fisher准确概率值），计量资料组间比较采用t检验（两独立样本t检验），检验水平＜0.05。结果：MSCT对结肠癌诊断准确度为100%，对肿瘤T分期的敏感度为92.86%，准确度为91.11%，阳性预测值86.36%，阴性预测值88%；对N分期敏感度达85.71%，准确度为80%，阳性预测值75%，阴性预测值85.71%。结论： 1、MSCT扫描作为一种新的检查方法可以有效地显示结肠癌的形态、大小和部位，对结肠肿瘤术前定位和判断肿瘤外浸润范围有一定价值； 2、MSCT扫描可清楚显示结肠癌远处脏器转移情况，对周围脏器侵犯和区域淋巴结转移的评估可为临床提供较好的参考价值； 3、MSCT扫描有望成为结肠癌术前分期的一个重要手段。
[Abstract]:Objective: colon cancer is a common malignant tumor in gastrointestinal tract. At present, the examination and diagnosis of colon neoplasms in China are mainly made by endoscopy X-ray radiography. Because of the advantages of direct image, biopsy and pathological results, colonoscopy has the advantages of simple operation and clear image. The advantages of low cost have become the screening methods for colon cancer, but these two methods have limitations on the thickening degree of colon cancer wall, invasion of intestinal wall, lymph node metastasis and distal organ metastasis. Multi-slice spiral CT(Multi-slice CT (MSCT) scan has the advantages of small trauma, fast speed, clear image, and can display lesions in many directions. It can be widely used in clinic. MSCT can be combined with CT virtual endoscopy (CT virtual copy) technology of axial and multiplanar recombination images. MSCT can effectively show the size, shape and location of the tumor, determine the range of tumor invasion, lymph node metastasis and distal organ metastasis, etc. MSCT plays an important role in the diagnosis of colon tumors. This study is to evaluate the diagnostic value of MSCT in colon neoplasms. Objective: to evaluate the value of MSCT in the diagnosis of colon tumors. Methods: from October 2009 to May 2011, 45 patients with colon cancer received abdominal MSCT examination in general surgery of second affiliated Hospital of Dalian Medical University. The preparation before examination was the same as that before colonoscopy. Contrast agent allergy test, 10 minutes before examination, intramuscular injection of hypotonic drugs, injection of air into the colon before scanning, routine abdominal cavity scanning and enhanced scanning. The resulting images were read by two or more imaging diagnostics with the title of attending physician or above. The location, shape, size, thickening degree of intestinal wall, infiltration around the lesion, lymph nodes (number, size, location and enhancement degree) and distant metastasis were diagnosed, and qualitative diagnosis and staging were made. Statistical analysis: SPSS13.0 software was used for statistical analysis, and the CT value of lesion was analyzed by repeated measurement counting variance analysis. X 2 test was used to test Fisher accurate probability value, and t test was used to compare counting data group (two independent samples t test, test level < 0.05). Results the accuracy of the diagnosis of colon cancer was 100, the sensitivity to T staging of tumor was 92.86, the accuracy was 91.1111, the positive predictive value was 86.36, the negative predictive value was 880.The sensitivity of N staging was 85.71l, the accuracy was 80, the positive predictive value was 755,85.71, and the negative predictive value was 85.71. Conclusion: As a new method, MSCT scan can effectively show the shape, size and location of colon cancer. 2MSCT scan can clearly show the distant organ metastasis of colon cancer. The evaluation of peripheral organ invasion and regional lymph node metastasis can provide a good reference value for clinic. MSCT scan is expected to be an important means of preoperative staging of colon cancer.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R730.44;R735.35

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