| Part I The Diagnosic Value of 16-Slices Spiral CT in the judgemen of invasion to serosa of Rectal CarcinomaObjective: To evaluate the value of judgemen of invasion to serosa of rectal carcinoma.Methods: 64 rectal carcinoma cases, women 28 and men 36 with average age 56.6 years old. CT scan was performed with 16-slice spiral CT in 64 rectal carcinoma cases,and compared CT findings and clinical material with pathologic diagnosis.Results: The sensitivity,specificity and accuracy,positive likelihood ratio and negative likelihood ratio of serous rough in 16-slice spiral CT to judge the serous infiltrated were 71%, 58%, 67%,1.69 and 0.5,respectively; and the sensitivity,specificity and accuracy, positive likelihood ratio and negative likelihood ratio of blurred fat space in 16-slice spiral CT to judge the serous infiltrated were 73%, 47%, 66%, 1.38, 0.57, respectively; The sensitivity,specificity and accuracy of combining rough serous with blurred fat space were 69%, 58%, 66%, respectively; The sensitivity, specificity and accuracy of serosa nodular for judg the serous infiltration were 20%, 100%, 44%, respectively.Conclusion: The synthetic analyses of the two signs both rough serous and blurred fat space could increase the accuracy of diagnosis. The authenticity of the sign of serosa nodular to judg the serous infiltration is 100%.Part2 Analysis the relative factors of serosa infiltration in rectal arcinomas by 16-Slices Spiral CTObjective: To evaluate the relative factors of serosa infiltrate in rectal carcinomas by 16-Slices Spiral CT.Methods: 64 rectal carcinoma cases, women 28 and men 36 with average age 56.6 years old. 16-Slices Spiral CT scanning were performed in 64 patiens ,of which 54 cases were performed by enhenced CT. tumor size,shape lymphadenectasis , the degree of mass enhancement and clinical data were analyzed. and compared with pathology .Results: The rate of local serous infiltrated in all patients was 70%;serosa invasion in rectal cancer cases was not significantly correlated with gender,age,increment of mass enhancement, intestinal circumference invasion,tumor size and differentiation tumor type (P>0. 05), but it was closely correlated with differentiation CT grouping, lymph node metastasis and carcinoma differentiation degree (P<0. 05). Conclusion: Of the influencing factors such as differentiation CT grouping , Lymph node metastasis and differentiation degree, differentiation degree is the most important factor in serosa invasion in rectal cancer patients.Part3 Assessment of diagnostic Value for Lymph Node metastasis of rectal carcinoma by16 -Slices Spiral CTObjective: To evaluate the diagnostic criterion for lymph node metastasis of rectal carcinoma by 16-slice spiral CT.Methods: Clinical data of 64 cases of rectal cancer proved by operation were analyzed,Pathologic findings were compared with the CT findings.Results: The criterions for lymph node metastasis on CT scans were 3mm,6mm,8mm,10mm in short-transverse diameter,the positive predictive value were 31%,37%,54%,75% ,respectively. The criterion was≥6 mm on CT scan in short-transverse diameter for lymph node,The sensitivity,specificity,accuracy and negative likelihood ratio were 63%,91%,81% and 0.2 respectively. Lymphatic metastatic rate in≤4 group ,4-9group as well as≥10 group of lymph node number were 6.25%,52.3%,29.6% respectively. The results to show a significantly higher rate of metastases in≤4 group than in 4-9 group as well as in≥10 group (P<0.05). Lymphatic metastatic rate was more higher in serosa invasion groop than normal serosa of rectal carcinoma.Conclusion: 16-Slices Spiral CT is a helpful method to assess the metastasis of lymph nodes in patients with rectal carcinoma. We suggest that the criterion of lymph node metastasis by CT scans is≥6mm in the short diameter. Lymphatic metastatic rate were higher when the number of lymph node were more than 4 or serous is infiltrated in rectal carcinoma.Part4 Comparative Study of Modified T staging Criteria by16-slice spiral CT and Pathological classification for rectal carcinomaObjective: To reevaluate the accuracy of 16-Slices Spiral CT staging criteria in rectal carcinoma, and make a reasonable staging of the disease.Methods: 16-Slices Spiral CT plain and enhancement scan were performed in patients with rectal cancer confirmed by pathology before surgery. 67 rectal carcinoma cases ,women 28 and men 39 with average age 58 years old,and the tumor size,thickness of the bowel wall and the invasion of surrounding were revaluated, the results were compared with the postoperative pathological results.Results: The preoperative 16-Slices Spiral CT scan materials of 67 patients analyzed according to Fleming CT criteria were well correlated (kappa=0.53) with clinical pathology staging. The data were also analyzed based on the criteria used by Patrick, and the results significantly correlated with those from pT classification (Kappa=0.56). We modified the T classification which was classified into four stages, the data obtained according to the criteria were significantly associated with those based on the pT classification (Kappa=0.67).Conclusion: Modified T criteria made a good consistency with imaging diagnosis and pathological diagnosis. It is of important value in assessing the degree of malignancy and patient's prognosis by preoperative CT appearance of rectal cancer. |
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