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Clinical Application Study of Preoperative Staging of Rectal Carcinoma by Multislice Spiral Computed Tomography

Author: ZhangJun
Tutor: LeiZhen
School: Liaoning Medical
Course: Medical Imaging and Nuclear Medicine
Keywords: Rectal cancer multislice spiral computed tomography Tumor staging Neoplasm staging
CLC: R735.37
Type: Master's thesis
Year: 2011
Downloads: 49
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Abstract

ObjectiveTo prelimnary investigate the conformity of the postoperative clinical and pathological results in rectal cancer T、N staging and mesorectal invasion extent with the image results of rectum-aerated MSCT scanning of rectal carcinoma. To approach the applied value in guiding clinical treatment of rectum-aerated MSCT scanning in rectal cancer preoperative T、N staging and mesorectal invasion extentMethodsCollected 98 patients with rectal cancer were confirmed by pathology, whose clinical information is complete, none of the patients without any treatment before surgery. Patients underwent inflatable rectal method, then used MSCT general scan and dynamic contrast enhanced scan, obtained the plain phase、artery and vein phase CT images and MPR (Multi-planar Reformation, MPR)、CPR(Curved Planar Reformation, CPR) images. Two radiologist read the films, predicted the T、N staging and evaluated the mesenteric infiltration of perirectal. Surgical patients by two surgery doctors, whom according to intraoperative findings and postoperative pathological findings, predicted the clinical T、N staging and evaluated the mesenteric infiltration of perirectal. Compare the two results, statistical analysis MSCT predict tumor T stage, N stage, the accuracy, sensitivity, specificity, positive predictive value , negative predictive value of mesenteric infiltration of perirectal, and the consistency of two diagnostic results.Results98 cases of patients were satisfied with the MSCT scans after filling the rectum, and pathological findings obtained after surgery.1.Comparison between image of MSCT T staging in rectal cancer and postoperative clinical pathological examinationThe preoperative CT performance: It was soft tissue density of tumor in plain scanning and it was regular or irregular enhancement obviously in arterial phase. The density of tumor was decreased in venous phase and it mean fast forward and fast out. It showed thickening or mass in wall of intestine and obvious enhancement in early stage. It showed that partial intestinal wall or all the intestinal wall and basal membrane are involved and invasion in another organ and soft tissue around tumor. The total accuracy of T staging by MSCT berore surgery was 90.82%, and≤T2 staging accuracy、sensitivity、specificity、PPV、NPV were 93.10%、93.10%、97.10%、93.10%、97.10%; T3 staging accuracy、sensitivity、specificity、PPV、NPV were 85.00%、77.27%、96.05%、85.00%、93.60%; T4 staging accuracy、sensitivity、specificity、PPV、NPV were 91.84%、95.74%、92.16%、91.84%、95.92%, and their respective in T2,T3,T4. Kappa value were 0.90、0.76、0.88(P<0.01). Concordance between MSCT and pathological findings is better.2.Comparison between image of N staging in rectal cancer and pathological examinationThe preoperative CT performance: There was no lymph node or without manifest enhancement lymph node in fat space of mesenterium in N0 stage. There were lymph node with regular or obvious enhangcement in fat space of mesenterium N1 and N2 stage. The diameter of lymph node was bigger than 8mm and some of them was become to be adhesion with irregular enhancement. The total accuracy of N staging by MSCT berore surgery was 90.82% and N0 staging accuracy、sensitivity、specificity、PPV、NPV were 92.00%、92.00%、97.26%、92.00%、97.26%; N1 staging accuracy、sensitivity、specificity、PPV、NPV were 80.95%、77.27%、94.74%、80.95%、93.51%; N2 staging accuracy、sensitivity、specificity、PPV、NPV were 94.23%、96.08%、93.62%、94.23%、95.65%, their respective in N0,N1,N2. Kappa value were 0.89、0.73、0.90(P<0.01). Concordance between MSCT and pathological findings was better.3 . Comparison between image of degree in mesorectum infiltration in rectal cancer and pathological examinationThe preoperative CT performance: It showed slight invasion of mesorectum with small range. Or density of mesorectum was increased and manifest invasion of mesorectum. The most severe invasion was destruction of mesorectum and another organ was involved.The total accuracy of degree in mesorectum infiltration by MSCT berore surgery was 94.90% andⅠdegree mesorectum infiltration accuracy、sensitivity、specificity、PPV、NPV were 96.97%、96.97%、98.46%、96.97%、98.46%;Ⅱdegree mesorectum infiltration accuracy、sensitivity、specificity、PPV、NPV were 81.82%、75.00%、81.82%、96.55%;Ⅲdegree mesorectum infiltration accuracy、sensitivity、specificity、PPV、NPV were 96.30%、98.11%、95.56%、96.30%、97.73%, their respective inⅠdegree,Ⅱdegree,Ⅲdegree. Kappa value were 0.95、0.75、0.94(P<0.01). Concordance between MSCT and pathological findings was better.ConclusionsInflatable rectal MSCT imaging reflected the biological information of preoperative T staging、N staging and mesenteric Infiltration extent of rectal cancer. MSCT can be the important non-invasive method of rectal cancer preoperative staging, and can provide guidance to clinical treatment protocols.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Intestinal neoplasms > Rectal cancer
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