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目的分析直肠癌淋巴结转移的相关CT表现,探讨与N分期相关的影像学规律。方法术前行盆腔CT检查的直肠癌病例59例,男38例,女21例,年龄36～80岁,中位年龄58岁。对切除标本进行淋巴结切片检查,以病理学诊断转移淋巴结阳性数为标准,按照美国癌症联合会(AJCC)N分期定义分为pN0、pN1、pN2组。采用影像工作站电影回放方式对所有病人图像进行复阅,观察盆腔淋巴结数目、大小、分布、原发肿瘤的浆膜表现及是否环周生长等情况,由2位放射医生盲法阅片并达成一致。统计方法选用KruskalWallis秩和检验及χ2检验。结果所有淋巴结转移阳性病例在CT均有淋巴结显示,pN0、pN1及pN2组CT检出的最大淋巴结径线随转移程度进展逐渐增大,分别为(4.13±3.21)mm、(7.43±3.27)mm和(10.27±3.88)mm,差异有统计学意义(χ2=23.842,P<0.01);pN0、pN1及pN2组CT检出淋巴结数目随转移程度进展逐渐增多,平均数目分别为(3.40±2.75)枚、(5.07±3.02)枚、(8.93±2.99)枚,差异有统计学意义(H=21.834,P<0.01);各组检出淋巴结的径线其差异有统计学意义(H=32.037,P<0.001)。单纯直肠旁淋巴结显示、肠旁和直肠上动脉旁同时显示及合并髂血管旁淋巴结显示的淋巴结转移分别为3例(3/12),17例(17/29)和8例(8/11),淋巴结分布方式在pN0、pN1、pN2组差异有统计学意义(χ2=19.517,P<0.05)。直肠癌淋巴结转移组CT表现为浆膜异常及环周生长者均高于非转移组,差异有统计学意义(χ2=8.979,P<0.01;χ2=5.107,P<0.05)。结论直肠癌淋巴结有无转移及转移程度不仅与淋巴结大小有关,还与淋巴结CT检出数目和淋巴结分布方式及癌肿浆膜和(或)外膜、环周生长情况有关。综合分析CT检出淋巴结的大小、数量、分布、癌肿浆膜和(或)外膜及环周生长等相关因素有助于提高CT直肠癌N分期的准确性。
Objective To analyze the CT findings of lymph node metastasis in rectal cancer and to explore the imaging regularity associated with N staging. Methods Preoperative pelvic CT examination of 59 cases of rectal cancer cases, 38 males and 21 females, aged 36 to 80 years, with a median age of 58 years. Lymph node biopsy was performed on the resected specimens. The pathological diagnosis of metastatic lymph nodes as the standard, according to the American Cancer Society (AJCC) N stage is divided into pN0, pN1, pN2 group. All the patients’ images were reviewed with video workstation movie playback mode to observe the number, size and distribution of pelvic lymph nodes, the serosal manifestations of primary tumors and whether or not peripheral growth were observed by two radiologists. . Statistical methods used KruskalWallis rank sum test and χ2 test. Results All cases with lymph node metastasis showed lymph nodes in CT. The maximum lymph node diameter detected by CT in pN0, pN1 and pN2 groups increased with the progression of metastasis (4.13 ± 3.21 mm, (7.43 ± 3.27) mm (10.27 ± 3.88) mm, the difference was statistically significant (χ2 = 23.842, P <0.01). The number of lymph nodes detected by CT in pN0, pN1 and pN2 groups gradually increased with the progression of metastasis, the average numbers were (3.40 ± 2.75) (5.07 ± 3.02), (8.93 ± 2.99), the difference was statistically significant (H = 21.834, P <0.01). There was significant difference in the diameter of lymph nodes detected in each group (H = 32.037, P <0.001). Simple pararectal lymph nodes showed that three cases (3/12), 17 cases (17/29) and 8 cases (8/11) respectively showed lymph node metastasis on the side of the paraaral and rectal artery, The distribution of lymph nodes in pN0, pN1, pN2 group was significantly different (χ2 = 19.517, P <0.05). The CT findings of lymph node metastasis in rectal cancer patients with serosal abnormalities and peripheral growth were significantly higher than those in non-metastasis patients (χ2 = 8.979, P <0.01; χ2 = 5.107, P <0.05). Conclusions The degree of lymph node metastasis and metastasis in rectal cancer is not only related to the size of lymph nodes, but also related to the number of lymph nodes and the distribution of lymph nodes and the growth of cancer serosa and / or adventitia. Comprehensive analysis of CT detected lymph node size, number, distribution, cancer serosa and (or) adventitia and peripheral growth and other related factors help to improve the accuracy of N staging of CT rectal cancer.