目的：探讨直肠低张充气多层螺旋CT检查对直肠癌术前新辅助治疗疗效的评价。方法：回顾性分析33例经手术病理证实的直肠癌新辅助治疗前后直肠低张充气多层螺旋CT影像表现。从肿瘤所在肠壁厚度、肿瘤累及肠管周径的范围、累及肠管的长度范围、增强表现、侵犯层次、管周筋膜情况、管周淋巴结有无肿大、T分期进行分析判断。结果：新辅助治疗前后直肠低张充气多层螺旋CT检查对直肠肿瘤病变均显示良好，新辅助治疗前肿瘤部位肠壁厚度：4~10mm 7例；11~30mm 15例；31mm以上11例；累及肠管周径：1/3以内6例，1/3~1/2 11例，1/2以上未达全周8例，全周径8例。累及肠管长度：10mm以内4例；10~30mm有8例；30~50mm 14例；50mm以上7例。均为中度强化。侵犯黏膜层及黏膜下层7例；浆膜层15例；突破浆膜层11例。11例累及管周脂肪及筋膜。管周、腹腔及腹膜后淋巴结肿大15例；远处转移4例。T1期15.15%，T2期30.30%，T3期42.42%，T4期12.12%。新辅助治疗后肠壁厚度正常10例，4~10mm 5例；11~30mm 10例；31mm以上8例。累及肠管周径1/3以内15例；1/3~1/2 12例；1/2以上未达全部周径6例。累及肠管长度10mm以内13例；10~30mm 6例；30~50mm 10例；50mm以上4例。均为轻度强化。侵犯黏膜层及黏膜下层10例；浆膜层17例；突破浆膜层6例。管周脂肪及筋膜受累3例。管周、腹腔及腹膜后淋巴结肿大6例；远处转移2例。新辅助治疗后T分期变化为：T0期30.30%，T1期24.24%，T2期30.30%，T3期9.09%，T4期6.06%。结论：直肠低张充气多层螺旋CT检查可以对直肠癌新辅助治疗前后直肠癌作出良好的分期，能够正确判断直肠癌新辅助治疗后直肠癌的降期情况。
Abstract
Objective: To evaluate rectum cancer preoperative neoadjuvant therapy using hypotonic rectal air inflation MSCT. Methods: Imaging findings in 33 cases of pathologically confirmed colorectal cancer after neoadjuvant therapy were analyzed retrospectively. The assessment included: intestinal wall thickness at tumor site, the extent of tumor invlovement of intestinal circumference, the length of intestinal tumor, the features after enhancement, the peri-vascular fascia, lymph node enlargement, and T stage of tumor. Results: Hypotonic rectal air inflation MSCT pre- and post-neoadjuvant therapy can show the rectal lesion satisfactorily. Before therapy: the intestinal wall thickness at the tumor site was 4~10mm in 7 cases, 11~30mm in 15 cases, beyond 31mm in 11 cases. Involvement of the intestinal circumference: less than 1/3 in 6 cases, 1/3~1/2 in 11 cases, more than 1/2 less than whole circumference in 8 cases, whole circumferential involvement in 8 cases. The length of invlovement: less than 10mm in 4 cases, 10~30mm in 8 cases, 30~50mm in 14 cases, more than 50mm in 7 cases. All cases had moderate enhancement. Invasion of mucosal and submucosal layer in 7 cases, invasion of serosa in 15 cases, invasion beyond serosa in 11 cases. In 11 cases the peri-intestinal fatty tissue and fascia were invaded. Peri-intestinal, peritoneal and posterior peritoneal cavity lympy node enhargement were seen in 15 cases. Distant metastases in 4 cases. Occurrence of T1 stage was 15.15%, T2 stage was 30.30%, T3 stage was 42.42%, T4 stage was 12.12%. After therapy: the intestinal wall thickness became normal in 10 case, 4~10mm in 5 cases, 11~30mm in 10 cases, beyond 31mm in 8 cases, involvement of intestinal circumference less than 1/3 in 15 cases, more than 1/3 less than 1/2 in 12 cases, more than 1/2 less than whole circumference in 6 cases. Tumor length less than 10mm in 13 cases, 10~30mm in 6 cases, 30~50mmin 10 cases, beyond 50mm in 4 cases. All cases had mild enhancement. Invasion of mucosal and submucosal layer were seen in 10 cases, invasion of serosa layer in 17 cases, invasion beyond serosa in 6 cases. Peri-intestinal fatty tissue and fascia involvement in 2 cases. Peri-intestinal, peritoneal cavity and post-peritoneal cavity lymph node enlargement seen in 6 cases. Distant metastases were seen in 3 cases. After neoadjuvant therapy the changes of T stage were: T0 stage 30.30%, T1 stage 24.24%, T2 stage 30.30%, T3 stage 9.09%, T4 stage 6.06%. Conclusion: Hypotonic rectal air inflation MSCT is useful in evaluating the effect of neoadjuvant therapy and can accurately assessing the changes of T staging pre- and post-therapy.
关键词
直肠肿瘤 /
肿瘤辅助疗法 /
体层摄影术 /
螺旋计算机
Key words
Rectal neoplasms /
Neoadjuvant therapy /
Tomography /
spiral computed
