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目的评价口服大剂量甘露醇螺旋CT结肠造影(spiral CT colonography,SCTC)对大肠肿瘤性病变的诊断价值。方法27例志愿者及68例疑有结、直肠病变患者每人口服约1500ml等渗甘露醇后,肌注20mg山莨菪碱注射液,随后行螺旋CT三期扫描,并在工作站上进行多平面重建、最大密度投影,对正常组大肠进行准确分区,测量各区肠壁厚度、大肠管径和肠壁强化程度,并与病变肠管进行对照,对其结果进行统计学处理。根据肠道准备效果将SCTC分为3级。对手术病理证实的61例大肠肿瘤性病变进行回顾分析。结果所有受试者都成功完成了SCTC检查,其中1级52例,占54.7%,2级39例,占41.1%,3级4例,占4.2%,总满意度为95.8%。61例病人中有60例清晰显示病变,其中结直肠癌30例,淋巴瘤8例,脓肿8例,结肠息肉8例,转移瘤4例,盲肠类癌3例。1例<5mm结肠息肉SCTC未检出。SCTC对病变的敏感度为98.36%,特异度为76.9%。30例大肠癌SCTC正确分期27例,Duke分期的准确性为90%(27/30)。结论SCTC是一种简便、易行、经济实惠,能全方位、多维显示大肠肿瘤性病变的方法。
Objective To evaluate the value of oral large-dose mannitol spiral CT colonography (SCTC) in the diagnosis of colorectal neoplasm. Methods Twenty-seven volunteers and 68 patients with suspected knot and rectum were orally administered with about 1500ml of isotonic mannitol. After intramuscular injection of 20mg anisodamine, spiral CT three-phase scanning was performed, and multi-plane Reconstruction, the maximum density projection, the normal group of large intestine accurately partitioning, measuring the thickness of the intestinal wall, the diameter of the large intestine and the degree of intestinal wall strengthening, and with the lesion bowel control, the results were statistically analyzed. The SCTC was divided into 3 grades according to the intestinal preparation effect. Surgical pathology confirmed 61 cases of colorectal neoplasms were retrospectively analyzed. Results All subjects completed SCTC successfully. Among them, grade 1 was 52, accounting for 54.7%, grade 2 39, accounting for 41.1%, grade 3 4, accounting for 4.2% and total satisfaction 95.8%. Sixty-one of 61 patients clearly showed lesions, including 30 cases of colorectal cancer, 8 cases of lymphomas, 8 cases of abscesses, 8 cases of colon polyps, 4 cases of metastases and 3 cases of cecum carcinoids. 1 case <5mm colon polyps SCTC not detected. The sensitivity of SCTC to lesions was 98.36% and the specificity was 76.9%. Twenty-seven cases were correctly staged in 30 cases of colorectal cancer, and the accuracy of Duke staging was 90% (27/30). Conclusion SCTC is a simple, easy, affordable, comprehensive and multi-dimensional display of colorectal neoplasms.