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,P<0.001);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,P<0.001);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,P<0.001)。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。
Purpose To evaluate the diagnostic efficiency of spectral CT imaging combined with oral isotonic mannitol gastrointestinal hypotonic radiography in the diagnosis of preoperative T and N staging of rectal carcinoma. Materials and Methods Forty-seven patients with rectal cancer confirmed by surgery and pathology were included in this study, all the subjects underwent oral isotonic mannitol gastrointestinal hypotonic radiography prior to CT scan, then abdominal and pelvic plain and double-phase contrastenhanced CT scan in the spectral imaging mode was performed, the optimal contrast- to-noise ratio imaging were got by the spectrum analysis software, then T-stage was evaluated and compared with pathological T-stage： N-stage was evaluated using both traditional method and the spectral curve method, and compared with pathological N-stage. Results （1） All the 47 patients were able to successfully complete the examination and the rectal filling and lesion display were satisfactory; （2） the best diagnostic accuracy of T-stage by the monochromatic images was 83.0% （39/47）, which had a general correlation with pathologic results （Kappa=0.713, P〈0.001 ）; （3） the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of N-stage by the traditional method were 78.72%, 80.95%, 76.92%, 73.91% and 83.33%, respectively, which had a general correlation with pathologic results （Kappa=0.574, P〈0.001）： the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of N-stage by the Spectral curve method were 89.13%, 75.00%, 100.00%, 100,00% and 83.87%, respectively, which had a fair correlation with pathologic results （Kappa-0.772, P〈0.001）. Spectral curve method had higher Youden index for N-stage evaluation than traditional method （0.64 vs. 0.58）. Conclusion Oral isotonic mannitol gastrointestinal hypotonic radiography can provide a good rectal background, and it is a sate and reliable method for rectal examination, when combined with spectrum CT imaging, it is able to display the detail of lesions and identity the homology of lymph nodes, which might help to make more accurate preoperative T, N staging of rectal carcinoma.
出处
《中国医学影像学杂志》
CSCD
北大核心
2015年第11期839-843,共5页
Chinese Journal of Medical Imaging
