| Objective:The diagnosis of gastrointestinal disease used to depend on gastrointestinal barium imaging and traditional fiber endoscopy.with the rapid development of computed technology,which had being used in the diagnosis of gastrointestinal disease.But single axial CT scanning is not enough to detected the lesions,judged the locations and the relationship between lesions with adjacent structures.Compared with the application in nervous、respiratory and skeketal system,CT is development slowly in the diagnosis of gastrointestinal disease because of lumen peristalsis and filling condition,ansa interstinalis overlapping and so on.For the fast scaning speed、isotropic spatial resolution at the original image and advantage post-processing software,multi-slice spiral CT(MSCT)had being in a new milestone.as well gastrointestinal tract imaging diagnosis.various 3D post-processing softwares had arised in the diagnosis of gastrointestinal diseases.The objective of the study is to investigate the value of 128 multi-slice spiral CT and various 3D post-processing softwares and compare the accuracy as well as their respective advantages and disadvantages about various 3D post-processing softwares in diagnosis diseases of stomach and colon.The research choose patients who intend to have CT examinations of gastrointestinal tract as research objects.and the fiber endoscopy or surgery pathological results as the gold standard.before the scan all patients must do normalized bowel preparation.Methods:Prospective internalize 121 patients as the objects who were clinical suspectedwith gastrointestinal tract diseases and had spiral CT scan in our hospital during Jan 2014 to Feb 2016.(male,86;female,35;(median age,57.5 years;range,21~84).stomach group 59,colon group 62.All patients did normalized bowel preparation before the scan.43 cases just had plain scan,78 had plain and enhanced scan,all cases adopted spiral scan.After CT scanning 98 cases were received 3D reconstruction at workstation about multi-planar reconstruction,transparent imaging,simulation of lumen and CT virtual endoscopy respectively.The original and various kinds of 3D reconstruction images were comprehensive analyzed by 2 radiologists independently,image interpretation discrepancies were resolved by consensus.The 2 radiologists did not know the results of fiber endoscopy or surgery pathological.(1)Found lesions and judged properities of them on routine CT axial scan images then compared with clinical results(2)Found lesions 、 analyzed locations and properities of the lesions on four 3D kinds of reconstruction images respectively at 98 cases then compared with clinical results.(3).analyzed the locations of all the 32 lesions which had operation and fiber endoscopy then compared with fiber endoscopy results.(4).Analyzed the TNM staging on routine CT axial scan images and four kinds of 3D reconstruction images respectively about 30 maligant tumors which had operation.then compared with surgery results.The comparison of Count data adopted four table chi-square test,P < 0.05 showed statistically significant difference;calculated sensitivity,specificity,coincidence rate about detecting lesions on CT axial images and four kinds of 3D reconstruction images.Results:(1)121 cases had routine CT axial scan 、fiber endoscopy or surgery.The sensitivity of disease detection by CT axial scan was 71.29%,specificity was 65%,coincidence rate was 70.25%.There were ststistical significant differences in detecting the lesions when comparing routine CT axial scan to fiber endoscopy or surgery pathological.(P<0.05)(2)98 cases respectively had Multi-planar reconstruction,transparent imaging,simulation of lumen and CT virtual endoscopy three dimensional.the sensitivity,specificity,coincidence rate in detecting lesions about the four kinds of image reconstruction mode were respectively : MPR(87.65% 、 94.12% 、88.78%),SSD(82.05% 、 100% 、 85.71%),Ray-sum(83.75% 、 100% 、86.73%),CTVE(96.30%、100%、96.94%).Compared with clinical methods the coincidence rate was higher about CTEA than the other three kinds of reconstruction mode in detecting lesions(P<0.05).(3)98 cases had the four images 3D reconstruction mode respectively.The accuracy in qualitative diagnosis lesions were respectively: MPR 79.59%(78/79),SSD 76.53%(75/98),Ray-sum 75.51%(74/98),CTVE 87.76%(86/98).the accuracy of CTEA was higher than the others.(4)The accuracy was no ststistical significant difference between CT scan and fiber endoscopy on judgment the location of lesions preoperative at 32 cases(P>0.05).but CT scan had a higher accuracy than fiber endoscopy in judgment the location of lesions preoperative.(5).The accuracy was no ststistical significant difference between routine CT axial scan and 3D reconstruction images on T、N staging at 30 cases.but 3D reconstruction images had a higher accuracy compared with operation results than routine CT axial scan.Conclusion: multi-slice spiral CT scan and the various kinds of 3Dreconstruction technology have great clinical practical value in detecting gastrointestinal diseases,judging the locations or properities of lesions,and staging the maligant tumors with a normalized bowel preparation before.through which can make up for the shortage of fiber endoscopy.The various kinds of 3D reconstruction technology have their advantages and disadvantages,should be comprehensively analyzed of various reconstruction images,so as to provide more accurate information for clinic. |
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