MSCT多平面重建在结肠癌术前诊断与邻近组织侵犯评估中的价值

Value of multiplanar reconstruction of MSCT in preoperative diagnosis and evaluation of adjacent tissue invasion in colon cancer

    摘要
  • 摘要:
    目的 分析多层螺旋CT（MSCT）多平面重建技术在结肠癌术前诊断与邻近组织侵犯评估中的价值。
    方法 回顾性分析2022年1月至2024年12月天津港口医院收治的100例疑诊结肠癌患者男性62例、女性38例，年龄（51.4±5.2）岁的临床资料，所有患者均于术前行MSCT增强检查，以手术后组织病理学检查结果为“金标准”，对比MSCT薄层重建技术与MSCT薄层重建+多平面重建技术对结肠癌的诊断效能，以及对结肠癌邻近组织侵犯评估结果和肿瘤、淋巴结、转移（TNM）分期诊断的准确率。计数资料的组间比较采用χ2检验或Fisher确切概率法。
    结果 100例疑诊结肠癌患者中，经手术后组织病理学检查确诊结肠癌93例，另7例患者确诊为结肠息肉4例、炎症性肠病3例。MSCT薄层重建+多平面重建技术对结肠癌诊断的灵敏度和准确率均高于MSCT薄层重建技术灵敏度：98.92%（92/93）对90.32%（84/93），准确率：99.00%（99/100）对89.00%（89/100），χ2=6.764、8.865，P=0.009、0.003，MSCT薄层重建+多平面重建技术对结肠癌诊断的特异度与MSCT薄层重建技术的差异无统计学意义100%（7/7）对71.43%（5/7），Fisher确切概率法，P=0.462。手术后组织病理学检查确诊为结肠癌的93例患者共123个病灶（21例患者为多发结肠癌），其中全层病灶69个，占56.10%；固有肌层病灶31个，占25.20%；黏膜下层病灶16个，占13.01%；黏膜层病灶7个，占5.69%。MSCT薄层重建+多平面重建技术对结肠癌邻近组织侵犯的检出率98.37%（121/123）对82.93%（102/123），χ2=17.314，P<0.001和TNM分期诊断的准确率96.77%（90/93）对89.25%（83/93），χ2=4.052，P=0.044均高于MSCT薄层重建技术。
    结论 MSCT多平面重建技术在结肠癌术前诊断中具有较高的诊断效能，可准确评估结肠癌的邻近组织侵犯及TNM分期，为患者手术方案的制定提供参考。

     

    Abstract:
    Objective To analyze the value of multi-slice spiral CT (MSCT) multiplanar reconstruction technique in the preoperative diagnosis of colon cancer and the evaluation of adjacent tissue invasion.
    Methods  The clinical data of 100 patients with suspected colon cancer admitted to Tianjin Port Hospital from January 2022 to December 2024 were retrospectively analyzed, including 62 males and 38 females, with an age of (51.4±5.2) years. All patients underwent MSCT enhanced examination before surgery. With the results of postoperative histopathological examination as the "gold standard", the diagnostic efficacy of MSCT thin-slice reconstruction and MSCT thin-slice reconstruction+multiplanar reconstruction for colon cancer, and the evaluation results of adjacent tissue invasion and the accuracy of tumor, node, metastasis (TNM) staging diagnosis were compared. Chi-square test or Fisher exact probability method was used for comparison of count data between groups.
    Results  Among the 100 patients with suspected colon cancer, 93 cases were confirmed as colon cancer by postoperative histopathological examination, and the other seven cases were confirmed as four cases of colonic polyps and three cases of inflammatory bowel disease. The sensitivity and accuracy of MSCT thin-slice reconstruction+multiplanar reconstruction in the diagnosis of colon cancer were higher than those of MSCT thin-slice reconstruction (sensitivity: 98.92% (92/93) vs. 90.32% (84/93), accuracy: 99.00% (99/100) vs. 89.00% (89/100), χ2=6.764, 8.865; P=0.009, 0.003). No statistically significant difference was observed in the specificity of colon cancer diagnosis between MSCT thin-slice reconstruction+multiplanar reconstruction and MSCT thin-slice reconstruction (100% (7/7) vs. 71.43% (5/7), Fisher exact probability method, P=0.462). A total of 123 lesions were found in 93 patients confirmed as colon cancer by postoperative histopathological examination (21 patients had multiple colon cancers), including 69 full-layer lesions, accounting for 56.10%; 31 muscularis propria lesions, accounting for 25.20%; 16 submucosal lesions, accounting for 13.01%; and seven mucosal lesions, accounting for 5.69%. The detection rate of adjacent tissue invasion (98.37% (121/123) vs. 82.93% (102/123), χ2=17.314, P<0.001) and the accuracy of TNM staging diagnosis (96.77% (90/93) vs. 89.25% (83/93), χ2=4.052, P=0.044) of MSCT thin-slice reconstruction+multiplanar reconstruction for colon cancer were higher than those of MSCT thin-slice reconstruction.
    Conclusions MSCT multiplanar reconstruction has high diagnostic efficacy in the preoperative diagnosis of colon cancer. It can accurately evaluate the adjacent tissue invasion and TNM staging of colon cancer and provide a reference for the formulation of surgical plans for patients.

     

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