多层螺旋CT在结肠癌诊断和分期中的临床应用

【作者】 王锡明；

【导师】 武乐斌；

【作者基本信息】 山东大学 ， 影像医学与核医学， 2005， 博士

【摘要】 目的:应用多层螺旋CT成像技术对大肠进行分区并对各区肠壁厚度进行测量,旨在观察正常大肠的解剖结构,测量并制定各区肠壁厚度的正常值。 材料与方法:对50例正常成年人应用多层螺旋CT进行全结肠扫描,并对其中的28例进行双期强化扫描,观察大肠的正常解剖结构,并按大肠的解剖分区法对各被检者大肠的进行分区,应用光标分别测量各区肠壁厚度,应用统计学方法对大肠各区的肠壁厚度进行分析,计算大肠各区正常厚度区间,并应用两两比较法对各区肠壁厚度进行比较,观察其有无显著性差异。 结果:50例被检者大肠的MSCT轴位图像及后处理重建的VR及SSD重建图像均可清晰的显示带、袋、垂及结肠皱襞等正常结构,其中行强化扫描的28例患者的动脉期轴位强化图像可清晰地显示大肠壁的结构,应用重建图像均能比较准确地对大肠进行分区,测量并计算出各被检者各区肠壁厚度的正常值。盲肠:3.15±0.22 mm,升结肠和横结肠1.33±0.16 mm,降结肠和乙状结肠为1.36±0.18 mm,直肠区为3.38±0.28 mm。 结论:多层螺旋CT不但能够清晰地显示大肠的正常解剖结构,动脉期强化扫描图像可以观察肠壁的解剖结构,同时其后处理重建图像亦可比较准确地对大肠进行分区,测量并计算出正常人不同区域肠壁厚度的正常值。更多还原

【Abstract】 Part ⅠEVALUTION OF MULTISLICE SPIRAL CT IN LARGEINTESTINE SUBAREA AND MEASURINGINTESTINAL WALL THINCKNESSObjective:The purpose of this study was to evaluate the value of Multi-spiral CT in large intestine subarea and measuring intestinal wall thickness.Materials and methods: A study of 50 adults (with no intestinal disease) underwent multi-spiral scans. Including: All adults were scanned with 2D and axial imaging using multi-spiral CT and 28 adults underwent dual-phase contrast within one breathhold each. All multi-spiral CT image was reviewed by two radiologist who were subarea and measured the intestinal wall thickness.Results: The colonic normal structure of 50 patients were showed by MSCT. And the normal structure of colonic wall of contrasted patients were displayed too. All adults were correctly subarea and were measured intestinal wall thickness of different district. The colonic thickness of caecum, ascend colon ,transverse colon lowe rcolon and sigmoid flexure were 3.1S±0.22mm, 1.33±0.16mm, 1.36±0.18mm and 3.38±0.28mm respectively.Conclusions: Multi-spiral CT could not only be subarea from more planes and angles, but also be useful in measuring intestinal wall thickness of different district.Part ⅡTHE VALUE OF MULTI-SLICE CT IMAGING TECHNIQUE IN THE DIAGNOSIS OF COLONIC CANCER Objective: To evaluate the ability of MSCT Imaging technique in the application of colonic tumor comparing with electron colon morror and barium enema.Methods:70 patients with colonic cancer were scanned in prone position,with colon cleared, drug-induced hypotonia and air filling colon by MSCT and reconstructed the image using workstation, such as volume rendering、CTVE、 SSD and so on. Then they diagnosed. 36 of them underwent electron colon mirror, and 56 of them underwent double contrast barium enema (DCEB). All patients were diadnosed using the imaging technique of MSCT. And the images of VR and SSD using MSCT compared with barium enema. CTVE of MSCT compared with electron colon mirror. MSCTC was evaluated in the dignosis of colonic cancer. And the image of CTVE and MPR combied with CTVE were compared with the results of electron colon mirror.Results: MSCT correctly detected all tumours.The accuracys of 64 MSCT、 DCBE、 FCM were 100%,73.21% and 83.33% respectively. The accuracy of MSCT is more high than the other examination.Conclusions: MSCT is recommended for the diagnosis of colonic cancer.Part ⅢTHE APPLICATION OFMULTI-SLICE CT DYNAMIC ENHANCEMENT SCAN IN THE DIAGNOSIS OFTHECOIONIC CANCER Objective: To improve the value of Multi-slice CT in the diagnosis of the colonic cancer.Methods: 70 patients with colonic cancer underwent multi-slice CT dynamic enhancement scans in prone position,with colon cleared, drug-induced hypotonia and air filling colon by MSCT and reconstructed the image using workstation, images of axial and reconstructive images of MPR , SSD , VR , MIP , CTVE and combined MPR and CTVE images were analyzed, patients were respectively diagnosed , staged and evaluated pre-operationally .Results: Tumors located in cecum , ascending colon transverse colon , descending colon and sigmoid colon were 16, 12, 8, 6, 28 patients respectively. Well-differentiated adenocarcinoma, middle-differentiated adenocarcinoma, poorly differentiated adenocarcinoma and mucinous carcinomas were 16, 18, 32, 4 respectively. 70 patients with arterial stage haved special represent. 33 patients with the tumors of well-differentiation represented equality contrast.37 patients with the tumors of poorly differentiation represented inequality contrast or layer contrast. According to the representation the accuracy rate of staging and accuracy rate of evaluation pre-operationally were 90.00% and 96.67% respectvely.Conclusion: MSCT dynamic scan have distinctive superiority in diagnosis and treatment of the colonic tumor.更多还原