结直肠腺癌黏液腺癌管壁和管腔多层螺旋CT表现的相关性分析

摘要

目的：分析结直肠腺癌、黏液腺癌管壁和管腔多层螺旋 CT 表现的相关性。方法收集术后有病理资料的120例结直肠腺癌和黏液腺癌病例。采用 GE Discovery CT 750HD 扫描仪行平扫、动脉期、门静脉期和延时期扫描。观察平扫及增强后病变肠壁、管腔及近端正常管腔的表现，并进行必要的数值测量。结果病变肠壁呈环形不均匀增厚，半球形增厚。平扫腺癌病变肠壁均匀或不均匀，黏液腺癌均不均匀。增强后腺癌呈均匀和不均匀强化，黏液腺癌呈3层结构或2层结构的分层征及类囊肿征。管腔狭窄根据形态分为自然流线型狭窄、不规则固定型狭窄、不规则缩窄型狭窄。病变近端正常管腔表现为闭合、轻度扩张或重度扩张。结论病变肠壁内纤维成分与低密度坏死、“黏液层”“黏液湖”的比例，决定病变肠壁柔软和僵硬程度；病变管壁柔软和僵硬程度，决定病变管腔的形态；病变管腔形态决定肠梗阻程度。因此，依靠这些特征，CT 检查就可以做出结直肠腺癌和黏液腺癌的诊断。%Objective To analyze the characteristions of the wall and lumen of colorectal mucous adenocarci‐noma by three stages enhanced scan of multi‐slice spiral CT .Methods One hundred and twenty cases of colorectal mucinous adenocarcinoma with complete pathologic diagnosis were studied .GE Discovery CT 750HD scanner was used for line scan ,arterial and portal venous phase scan ,and delayed scan .The lesions of intestinal wall ,enteric cavity and proximal normal lumen were observed by line scan and enhanced scan ,the related quantitative value and CT value were observed ,and statistical treatment were done.Results The intestinal wall showed uneven annular thickening or hemispherical thickening .Lesions walls of colonic carcinoma were homogeneous and inhomogeneous , while walls of mucous adenocarcinoma were homogeneous before enhanced .Lesions walls of colonic carcinoma were homogeneous and inhomogeneous ,while mucous adenocarcinoma with three or two layers structure and type of cyst .According to the forms ,the stenosis was divided into :natural streamlined ,irregular fixed ,and irregular constrictive types .The proximal normal intestinal canal of the lesion showed occlusion ,mild expansion or severe expansion .Conclusion The proportion of fiber ingredients ,low‐density necrosis and the "mucilage lake" in the in‐testinal wall decided the rigid degree of the lesions ,the rigid degree decided the form of lumen lesions ;and the form of lumen lesions decided the obstruction degree of the intestinal canal .Therefore ,with these characteristics , the diagnosis of colorectal adenocarcinoma or mucous carcinoma can be made by CT examination .