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The value of "rigid wall" sign in the evaluation of infiltration depth of early colorectal tumorsOBJECTIVE:CT colonography was rarely used to evaluate the depth of invasion of colorectal tumors.The "rigid wall" sign was a new method to evaluate the infiltration depth of colorectal tumors.The diagnostic consistency and the value of CT colonography in evaluating the infiltration depth of early colorectal tumors were not clear.The purpose of this study was to clarify the consistency of the diagnosis of "rigid wall" and to explore the value of this sign for the infiltration depth of early colorectal tumors.Materials and Methods:Colorectal tumor lesions with pathological stage of Tis-T2 were enrolled.All lesions had good CT colonography image quality before treatment.The diagnostic confidence and final diagnostic results of the lesions with or without "rigid wall"sign were evaluated by two imaging doctors.The diagnostic confidence of "rigid wall"sign was divided into five grades.From high to low,followed by positive,possible,uncertain,impossible and certainly not.According to the results of diagnostic confidence,the signs of "rigid wall" were finally determined.A consistency analysis was performed on the diagnostic confidence and results of the two doctors.Correlation analysis was made between the diagnostic confidence of the two doctors and the depth of tumor invasion,and the "rigid wall" signs of different infiltration depth tumors were compared between groups.According to the results of the evaluation of the "rigid wall" sign by two doctors,the infiltration depths<T1 and?T1a(superficial submucosa)were predicted and evaluated.RESULTS:A total of 242 colorectal tumors were enrolled in the study.Tis,Tla(superficial submucosa),T1b(deep submucosa),T2a(superficial muscle)and T2b(deep muscle)were 43,21,35,62 and 81 lesions respectively.The diagnostic confidence of the two observers on the sign of "intestinal wall stiffness" was significantly positively correlated with the depth of tumor invasion,with correlation coefficients of 0.792 and 0.881,respectively.The two observers showed moderate consistency in diagnostic confidence(Kappa=0.539),but high consistency in final diagnostic results(Kappa=0.81).The results of the evaluation of the "rigid wall" sign were used to predict the infiltration depth?T1 and ?T1a.The area under the ROC curve of the two observers was 0.859?0.887and 0.855?0.859,respectively.Conclusion:The sign of "rigid wall" was positively correlated with the depth of tumor invasion,and the assessment of this sign was highly consistent.The "rigid wall" sign was a reliable sign for identifying early colorectal cancer and advanced colorectal cancer.Part ? The value of tumor morphology in CT colonography in the evaluation of infiltration depth of colorectal tumorObjective:Tumor morphology was important for the assessment of infiltration depth of colorectal tumor with colonoscopy,but the value of CT colonography for tumor risk assessment was not clear.The purpose of this study was to explore the value of tumor morphology in CT colonography in evaluating the infiltration depth of colorectal tumor,focusing on the value of tumor morphology in the early colorectal tumor.Materials and Methods:Colorectal tumors with pathological stage Tis-T2 were enrolled.All lesions had good CT colonoscopy image quality before treatment.Image evaluation was performed by a radiologist,and the indicators evaluated included tumor size,morphological morphology,ulcers,and tumor morphological classification.The morphology of pedicel was divided into three types:pedicel,sub-pedicel and no-pedicel;tumor morphological classification was divided into oval,lobulated,laterally spreading tumor,abnormal of surface structure and depressed types.Tumors with different infiltration depths were divided into five groups according to pathological results,namely Tis,T1a,T1b,T2a and T2b.The differences in tumor size,morphological morphology,ulcers and tumor morphological classification were compared between different invasive depth tumors.Univariate and multivariate analysis of the above indications were performed with ?T1a tumor as the dependent variable,then independent risk factors for predicting ?T1a tumors were determined.Results:A total of 242 colorectal tumor lesions were enrolled,with Tis,T1a,T1b,T2a,and T2b being 43,21,35,62,and 81 lesions,respectively.Tumor size was of no value in assessing the infiltration depth of early colorectal tumors.The tumor peduncular structure was a protective factor for deep infiltration of the tumor.As the peduncular structure disappears,the infiltration depth of tumor gradually increased.Ulcer was an important sign of infiltration depth>T1b,with sensitivity,specificity and accuracy of 95.9%,61.1%and 82.2%,respectively.Among the morphological types of tumors,depression type had the highest degree of malignancy,with 100%submucosal infiltration and 98.5%submucosal deep infiltration.The main types of oval and lobulated lesions were intramucosal carcinomas,accounting for 65.2%and 64%respectively.laterally spreading tumors were all early cancers,and the proportion of deep submucosal infiltration was 42.9%.Abnormal surface lesions accounted for a certain proportion in all pathological stages,but intramucosal carcinomas accounted for the lowest proportion(12.2%),while T1b and T2a tumors accounted for 28.6%and 30.6%respectively.With?T1a tumor as the dependent variable,univariate analysis showed that the tumor site,peduncular structure,ulcer,and tumor morphological classification were different in<T1a or>T1a tumors,while multivariate analysis showed that only ulcer and tumor morphological classification were independent predictors.Conclusion:Morphological analysis of colorectal tumor with CTC were of great value in the evaluation of infiltration depth.Ulcer and morphological typing were independent predictors for ?T1a tumors.Part ? Risk prediction model for infiltration depth of early colorectal cancer with CT colonographyObjective:To establish a risk prediction model for colorectal tumors with infiltration depth?Tla by analyzing the characteristics of intestinal wall and tumor morphology with CTC.Materials and Methods:Colorectal tumors with pathological stage of Tis,T1 and T2 were enrolled.All lesions had good CT colonoscopy image quality before treatment.Image evaluation was performed by a radiologist.The indicators included tumor location,size,peduncular structure,ulcer,tumor morphological classification,"rigid wall" sign and adventitia.The tumor site was divided into two classification according to the colon and the rectum;the peduncular structure was divided into three types:pedicel,sub-pedicel and non-pedicel;the ulcer was divided into two categories by presence and absence;the morphological classification of the tumor was classified with oval,lobulated,laterally spreading tumor,abnormal surface structure and depression types."rigid wall" sign was divided into two categories with presence and absence;the adventitia was divided into two types by smooth or rough outer membrane surface.Using the tumor infiltration depth T1a<as the dependent variable,logistic regression was used to analyze the above indicators and the gender and age of the patients by univariate analysis and multivariate analysis.According to the results of multivariate analysis,Tla ? tumor prediction nomogram and ROC curve were made using R language.Results:Univariate analysis showed that the patient's age,gender,and tumor size were not risk factors for predicting the infiltration depth of colorectal cancer.Multivariate analysis showed that only the morphological classification and the "rigid wall" sign were independent risk factors for prediction of tumor with invasive depth T1a?.The predictive nomogram of invasive depth?T1a tumor was established with the "rigid wall" sign and tumor morphological classification as independent factors.The prediction accuracy of<T1a tumor was 95.9%,and the model had good calibration degree.Conclusion:CTC tumor morphological classification and "rigid wall" signs were independent risk factors for prediction of invasive depth T1a?tumors.The predictive risk model of invasive depth?T1a tumor had good calibration. |
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