| Objective: Colorectal disease is a relatively common type of digestivediseases,.In recent years, there is an upward trend in the incidence of rectalcancer and it has become one of the common malignant tumors. Oncediagnosed, rectal cancer is genenrelly designated as locally advanced or latelocally advanced. Because at the beginning, patients rarely exhibit symptomsof the disease. For that reason, Cancer staging is the key to the treatment ofrectal cancer.Transrectal ultrasound, which can have a real-time and dynamicobservation of lesions and is characterized by high resolution, is widely usedin preoperative cancer staging and postoperative evaluation. Whether acancer is benign or malignant can be determined by analysis of vessels withinthe tumor used color Doppler ultrasound, including its the peak systolicvelocity (PSV), end diastolic velocity (EDV) and resistance index (RI),combined with hemodynamic characteristics and the results oftwo-dimensional ultrasound. Contrast-enhanced ultrasound can clearly displaythe blood perfusion of microcirculation, thus significantly increase the imagecontrast reslolution, and is of great value in the further assessment of theevaluation of tumor malignancy.The purpose of this study is to investigate thevalue of conventional ultrasound combined with transrectal ultrasoundcontrast in the diagnosis of rectal diseases.Methods:The study was conducted at the Department of Surgery in TheFourth Affiliated Hospital of Hebei Medical University in China from October2011to November2012.91cases of rectal tumor patients. The age20-82years,mean62.8±11.4years old.57cases are rectal cancer(male32cases,female25cases),34cases are colorectal adenomas(male21cases,female 13cases). All rectal cancer patients took the observed lesions characteristics ofconventional two-dimensional ultrasound and color flow signal, select theclear arteries and measured peak systolic flow velocity (PSV), end-diastolicvelocity (EDV) and resistance index (RI), and analysis the diagrams. Thepatients were divided into4levels based on blood flow signal, running and thetumor blood vessels: level0-no blood flow signal within and around themasses; level1-a small amount of blood flow within the tumor grade, visible1-2strip flow within the tumor grade; level2-the amount of blood flow, clearvascular, running straight; Level3-rich blood flow, internal visible rich bloodflow signals, tortuous irregular seen around the blood vessels surrounding.In addition to the patient who is not suitable for ultrasound imaging,theremaining46cases(male26cases,female20cases,age20to77years old, mean56.1±13.2years old) of rectal tumor patients were used the SonoVue contrastmedia transrectal ultrasound contrast enhancement method, strengthen thecharacteristics were observed, and the quantitative analysis the images,rendering the normal bowel wall, rectal lesions regional blood perfusiontime-intensity curve (TIC) and analysis of all angiographic parameters.In91cases of patients before operation and underwent TRUS andmultislice spiral CT(MSCT) examination were68cases (male37cases,female31cases,age32to74years old,mean55.2±10.3years old).MSCTexamination method application of Siemens spiral scanner, scan range fromthe hepatic dome to the pelvic floor, scan thin layer around the lesion, and ifnecessary, line enhanced scan. Tumor TNM was staged by two doctor,including mass nature, depth of invasion and perirectal metastasis, depth ofinvasion, the number of the surrounding lymph nodes and the size distributionanalysisResults:1The pathological confirms57cases were rectal (32cases wereadenocarcinoma,21cases were mucinous adenocarcinoma,3cases weresignet ring cell carcinoma and1case were malignant stromal tumor).34patients of Colorectal adenomas (18cases were tubular adenoma,9cases were villous adenoma,4cases were tubular villous adenoma,2cases were villousadenoma and atypical hyperplasia,1cases were tubular adenomas atypicalhyperplasia).2Rectal ultrasonography of benign and malignant2.1Performance of conventional two-dimensional ultrasound:34cases ofrectal adenoma ultrasonography are shown tumor from mucosa to intestinalcavity uplift, a neoplastic growth, round or papillary, partially withpedicle,diameter of about1.4cm to4.7cm,slightly stronger echo,internal echostill uniform, probe the touch mobile.57cases of rectal carcinoma showed ahypoechoic mass, uneven internal echo,a bulge or ulcer type, irregular shape,invading the length of about1.7cm to6.9cm, and infiltrating into the layers ofrectal wall, of which38cases were perirectal lymph nodes,21cases invadedthe adjacent organs,4cases had liver metastasis.2.2Rectum benign and malignant blood flow patterns: rectal adenomavascular running rule, a single vascular, is a backbone to the tumor. Accordingto Adler DD’s standard of bloodstream classification, intratumoral radialdistribution flow classification with grade0-1,11cases of0grade,16cases ofgrade I,7cases of grade Ⅱ. Rectal cancer vascular distribution clutter,morphological diversity, tortuous vascular grading shape, mainly2-3level.0of0grade,11cases of grade I,20cases of grade II,26cases of grade Ⅲ. Theresults were statistical analysised (x2=40.991, P <0.01).2.3Hemodynamic parameters of rectal tumors: Rectal benign and malignanttumor can be detected in the arterial blood flow, measured the PW, colorectaladenomas PSV:14.15±3.40cm/s EDV:4.62±0.53cm/s RI:0.63±0.03;cancer PSV:18.64±2.51cm/s EDV:4.72±1.98cm/s RI:0.74±0.10. Rectalartery flow spectrum as a low resistance,the colorectal adenomas artery flowspectrum as high resistance. Both by statistical analysis, a significantdifference (P <0.05)3TRUS and MSCT on the depth of tumor invasion (T stage) results, T stagingaccuracy of TRUS diagnosis was76.4%(52/68); T staging accuracy ofMSCT diagnosis was58.8%(40/68). The accuracy of TRUS to determine T staging was higher than that of MSCT.4Contrast-enhanced ultrasound features of rectal tumors4.1Rectal benign lesion contrast mode: after injection of contrast mediumalmost simultaneously enhance the surrounding intestinal wall, synchro-nization subsided peak was enhanced, and enhance the way performance iscompared with uniform.4.2Rectal cancer ultrasound contrast mode: after injection of contrast mediumlesions showed rapid filling and subsided, early contrast agent quickly fills theentire tumor,a small part showed homogeneous enhancement,other partshowed inhomogeneous enhancement;later period showed rapid decline,andthe tumor and the surrounding normal intestinal wall formed obviousdifference; contrast of advanced lesions appeared as the center showed lowenhancement and the surrounding is slightly enhanced.4.3By analyzing the TIC curves derived the time to peak, peak intensity andarea under curve between benign and malignant group, the normal intestinalwall and vicious group differences were statistically significant (P<0.05).Benign group general observation on enhanced almost simultaneouslywith the surrounding intestinal wall,but the TIC curve obtained from the peaktime than normal bowel wall shorten.Both by statistical analysis, a significantdifference (P <0.05).Mean transit time between normal intestinal wall andvicious group,between benign and normal bowel wall group was statisticallysignificant(P <0.05).4.4Conventional ultrasound combined with ultrasound contrast sensitivi-ty,specificity and accuracy in the diagnosis of rectal lesions was significantlyhigher than conventional ultrasound.Conclusions:1Rectal tumor blood flow within the distribution, classification andhemodynamic indicators can provide a reference for mass properties.2TRUS was superior to MSCT for the diagnosis accuracy of staging inrectal cancer,.3This study was conducted on the rectal tumor contrast-enhanced ultrasound, to discuss the pathological group, malignant tumor of peakintensity, time to peak and area under the curve of malignant tumor ishigher than that of the benign tumor and normal intestinal wall around, andthere was significant difference between benign tumor and surroundingnormal; intestinal wall in the peak intensity, area under the curve has nostatistical significance, compared with statistical significance in normalintestinal wall the time to peak. Contrast-enhanced ultrasound provides moreintuitive basis for further identification of benign and malignant tumor.4Compared with conventional ultrasound,the sensitivity,specificity andaccuracy of conventional ultrasound combined with ultrasound contrast aresignificantly higher. And draw routine ultrasound as a basis for diagnosticultrasound contrast supplement routine ultrasound, both the Joint Inspectioncan significantly improve the diagnostic effect. |
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