【作者】 韩帅；

【导师】 李彩英；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 第一部分16层螺旋CT对直肠癌肿瘤浆膜面浸润的影像诊断目的:评价16层螺旋CT对直肠癌肿瘤浆膜面浸润的诊断价值。方法:采用16层螺旋CT对64例直肠癌病人进行平扫及增强三期扫描,男性36例,女性28例,平均年龄56.6岁。前瞻性分析影像表现,并与手术病理进行对照研究,对所得数据进行统计分析。结果:CT表现浆膜面毛糙,诊断浆膜面浸润的敏感性、特异性、准确性、阳性似然比及阴性似然比分别为71%、58%、67%、1.69、0.50;表现肿瘤层面浆膜外脂肪间隙模糊诊断浆膜面浸润的敏感度、特异度、准确性、阳性似然比及阴性似然比分别为73%、47%、66%,1.38,0.57;同时出现两种征象联合诊断浆膜面浸润敏感性、特异性、准确性为69%、58%、66% ;CT表现浆膜面外结节状突起的敏感性、特异性及准确性分别为20%、100%、44%。结论:联合两种征象作为判定浆膜面受侵诊断标准,特异性及准确性均较好,浆膜面结节诊断浆膜面浸润可靠性为100%。第二部分16层螺旋CT评价直肠癌浆膜面浸润相关因素分析目的:结合16层螺旋CT直肠癌影像表现及临床资料,探讨影响直肠癌浆膜面浸润的相关因素。方法:64例直肠癌手术患者,男性36例,女性28例,平均年龄56.6岁。所有患者术前均行16层螺旋CT平扫,观察肿块大小、形态、淋巴结肿大情况;54例行三期动态强化扫描:按照强化程度分型,结合临床资料,分析各因素与直肠癌浆膜面浸润的相关性。结果:全组病例浆膜面浸润率为70%;单因素分析显示,直肠癌癌肿浆膜面的浸润与患者的性别、年龄、肿瘤大小、肿瘤大体类型、肠管周径侵犯程度、肿瘤强化净增值均无相关性(P>0.05);而与肿瘤CT分型、肿瘤分化程度及淋巴结转移有相关性(P<0.05)。结论:直肠癌肿瘤CT分型、肿瘤的分化程度、淋巴结转移等均可影响肿瘤浆膜面浸润,其中肿瘤分化程度是影响肿瘤浆膜面浸润的最重要因素。第三部分采用16层螺旋CT诊断直肠癌淋巴结转移的初步研究目的:评价16层螺旋CT扫描对直肠癌淋巴结转移的诊断价值。方法:回顾性分析64例经手术病理证实的直肠癌CT表现,统计直肠肿瘤周围淋巴结肿大情况与术后病理结果进行对照分析。结果:以3mm、6mm、8mm、10mm短径为标准,直肠癌淋巴结转移的转移率分别为31%,37%,54%,75%。以6mm作为诊断标准时,敏感度及准确度分别为95%、47%,阴性似然比为0.2。淋巴结个数≤4枚,转移率为6.25%;4-9枚组,转移率为52.3%;淋巴结≥10枚组,转移率为29.6%,淋巴结≤4枚组与4-9枚组、≥10枚组之间比较差别有统计学意义(P<0.05);浆膜面浸润组淋巴结转移率(40%)明显高于无浆膜面浸润组(11%)(P<0.05)。结论: CT扫描有助于发现直肠癌癌肿周围肿大的淋巴结,淋巴结短径≥6mm提示直肠癌淋巴结转移,直肠周围淋巴结数目大于4枚及肿瘤浆膜层浸润淋巴结转移率明显提高。第四部分采用16层螺旋CT评价直肠癌T分级与病理对照研究目的:采用多层螺旋CT重新评价传统直肠癌CT分期,进一步制定合理的T分级。方法:67例经手术病理证实的直肠癌患者,前瞻性行术前多层螺旋CT盆腔平扫及增强扫描,男性39例,女性28例,平均年龄58岁,统计病变大小、肠壁厚度及周围浸润情况,并与术后病理对照分析。结果:按照Fleming分期标准分析CT资料并将T分为三期,与术后病理T分期对照,一致性较好(Kappa值=0.53);按照Patrick分期标准进行T分期,与病理分期对照,一致性较好(Kappa值=0.56);本研究结合病理分型制定改良T分期,与术后病理T分期对照,有较好的一致性(Kappa值=0.67)。结论:改良T分期标准与PTNM分期标准一致性好,通过直肠癌的CT征象分析,对术前判断肿瘤的恶性程度及患者预后有重要的价值。更多还原

【Abstract】 Part I The Diagnosic Value of 16-Slices Spiral CT in the judgemen of invasion to serosa of Rectal CarcinomaObjective: To evaluate the value of judgemen of invasion to serosa of rectal carcinoma.Methods: 64 rectal carcinoma cases, women 28 and men 36 with average age 56.6 years old. CT scan was performed with 16-slice spiral CT in 64 rectal carcinoma cases,and compared CT findings and clinical material with pathologic diagnosis.Results: The sensitivity,specificity and accuracy,positive likelihood ratio and negative likelihood ratio of serous rough in 16-slice spiral CT to judge the serous infiltrated were 71%, 58%, 67%,1.69 and 0.5,respectively; and the sensitivity,specificity and accuracy, positive likelihood ratio and negative likelihood ratio of blurred fat space in 16-slice spiral CT to judge the serous infiltrated were 73%, 47%, 66%, 1.38, 0.57, respectively; The sensitivity,specificity and accuracy of combining rough serous with blurred fat space were 69%, 58%, 66%, respectively; The sensitivity, specificity and accuracy of serosa nodular for judg the serous infiltration were 20%, 100%, 44%, respectively.Conclusion: The synthetic analyses of the two signs both rough serous and blurred fat space could increase the accuracy of diagnosis. The authenticity of the sign of serosa nodular to judg the serous infiltration is 100%.Part2 Analysis the relative factors of serosa infiltration in rectal arcinomas by 16-Slices Spiral CTObjective: To evaluate the relative factors of serosa infiltrate in rectal carcinomas by 16-Slices Spiral CT.Methods: 64 rectal carcinoma cases, women 28 and men 36 with average age 56.6 years old. 16-Slices Spiral CT scanning were performed in 64 patiens ,of which 54 cases were performed by enhenced CT. tumor size,shape lymphadenectasis , the degree of mass enhancement and clinical data were analyzed. and compared with pathology .Results: The rate of local serous infiltrated in all patients was 70%;serosa invasion in rectal cancer cases was not significantly correlated with gender,age,increment of mass enhancement, intestinal circumference invasion,tumor size and differentiation tumor type (P>0. 05), but it was closely correlated with differentiation CT grouping, lymph node metastasis and carcinoma differentiation degree (P<0. 05). Conclusion: Of the influencing factors such as differentiation CT grouping , Lymph node metastasis and differentiation degree, differentiation degree is the most important factor in serosa invasion in rectal cancer patients.Part3 Assessment of diagnostic Value for Lymph Node metastasis of rectal carcinoma by16 -Slices Spiral CTObjective: To evaluate the diagnostic criterion for lymph node metastasis of rectal carcinoma by 16-slice spiral CT.Methods: Clinical data of 64 cases of rectal cancer proved by operation were analyzed,Pathologic findings were compared with the CT findings.Results: The criterions for lymph node metastasis on CT scans were 3mm,6mm,8mm,10mm in short-transverse diameter,the positive predictive value were 31%,37%,54%,75% ,respectively. The criterion was≥6 mm on CT scan in short-transverse diameter for lymph node,The sensitivity,specificity、accuracy and negative likelihood ratio were 63%,91%,81% and 0.2 respectively. Lymphatic metastatic rate in≤4 group ,4-9group as well as≥10 group of lymph node number were 6.25%,52.3%,29.6% respectively. The results to show a significantly higher rate of metastases in≤4 group than in 4-9 group as well as in≥10 group (P<0.05). Lymphatic metastatic rate was more higher in serosa invasion groop than normal serosa of rectal carcinoma.Conclusion: 16-Slices Spiral CT is a helpful method to assess the metastasis of lymph nodes in patients with rectal carcinoma. We suggest that the criterion of lymph node metastasis by CT scans is≥6mm in the short diameter. Lymphatic metastatic rate were higher when the number of lymph node were more than 4 or serous is infiltrated in rectal carcinoma.Part4 Comparative Study of Modified T staging Criteria by16-slice spiral CT and Pathological classification for rectal carcinomaObjective: To reevaluate the accuracy of 16-Slices Spiral CT staging criteria in rectal carcinoma, and make a reasonable staging of the disease.Methods: 16-Slices Spiral CT plain and enhancement scan were performed in patients with rectal cancer confirmed by pathology before surgery. 67 rectal carcinoma cases ,women 28 and men 39 with average age 58 years old,and the tumor size、thickness of the bowel wall and the invasion of surrounding were revaluated, the results were compared with the postoperative pathological results.Results: The preoperative 16-Slices Spiral CT scan materials of 67 patients analyzed according to Fleming CT criteria were well correlated (kappa=0.53) with clinical pathology staging. The data were also analyzed based on the criteria used by Patrick, and the results significantly correlated with those from pT classification (Kappa=0.56). We modified the T classification which was classified into four stages, the data obtained according to the criteria were significantly associated with those based on the pT classification (Kappa=0.67).Conclusion: Modified T criteria made a good consistency with imaging diagnosis and pathological diagnosis. It is of important value in assessing the degree of malignancy and patient’s prognosis by preoperative CT appearance of rectal cancer.更多还原