Value of Rectum-Aerated MSCT for Preoperative Staging of Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Yinxu ¹ , ZHANG Junhua ¹ , LEI Zhen ² , ZHANG Jun. ²

1.Department of General Surgery， The First Affiliated Hospital of Liaoning Medical University, Jinzhou 121001, Liaoning Province, China;;
2.Department of Radiology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou 121001, Liaoning Province, China;

Corresponding author：

Keywords：

Rectal neoplasm; Mesorectum; Tomography/X-ray computed; N staging

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ObjectiveTo investigate the value of rectumaerated MSCT examination in diagnosis of mesorectal infiltration of rectal cancer and lymph node metastasis staging. MethodsFrom January 2010 to July 2010, the data of 68 patients with rectal cancer confirmed by pathology were analyzed in the First Affiliated Hospital of Liaoning Medical University. All the patients underwent rectumaerated MSCT preoperatively and postoperative pathology was taken as the gold standard for evaluation of the accuracy, sensitivity, specificity, positive or negative predictive values of MSCT in diagnosis of mesorectal infiltration and lymph node metastasis.ResultsIn rectum-aerated MSCT scanning, rectum and sigmoid colon was fully expanded, perirectal fat space was clear between perirectal fat space and relatively high density rectal wall and very low density enteric cavity. For mesorectal infiltration of degree Ⅰ, Ⅱ, and Ⅲ, the accuracies were 92.6%（63/68）, 91.1%(62/68), and 95.6%(65/68), respectively; sensitivities were 91.2%(31/34), 85.0%(17/20), and 92.9%(13/14), respectively; specificities were 94.1%(32/34), 93.8%(45/48), and 96.3%(52/54), respectively; positive predictive values were 93.9%(31/33), 85.0%(17/20), and 86.7%(13/15), respectively; negative predictive values were 91.4%(32/35), 93.8%(45/48), and 98.1%(52/53), respectively. For lymph node metastasis in N0, N1, and N2, the accuracies were 92.6%(63/68）,85.3%(58/68）, and 92.6%(63/68）, respectively; sensitivities were 86.2%(25/29), 90.0%(27/30), and 66.7%(6/9), respectively; specificities were 97.4%(38/39), 81.6%(31/38), and 96.6%(57/59), respectively; positive predictive values were 96.2%(25/26), 79.4%(27/34), and 75.0%(6/8), respectively; negative predictive values were 90.5%(38/42), 92.1%(35/38), and 95.0%(57/60), respectively. ConclusionsRectumaerated MSCT scaning can clearly show the depth of rectal carcinoma infiltration in the mesorectum, and N staging of mesorectal lymph node metastasis of MSCT has a higher consistency with that of pathological staging. Rectumaerated MSCT scanning is an important referenced method for clinical preoperative staging and individualized chemotherapy regimen.

Citation： ZHANG Yinxu,ZHANG Junhua,LEI Zhen,ZHANG Jun.. Value of Rectum-Aerated MSCT for Preoperative Staging of Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(8): 902-906. doi: Copy

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2.	禚洪庆, 周岩冰, 吕亮, 等. 直肠癌直肠系膜浸润程度的术前螺旋CT与术后病理对照研究 [J]. 中华外科杂志, 2009, 47（8）: 599602.
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9.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery－the clue to pelvic recurrence? [J]. Br J Surg, 1982, 69(10): 613616.
10.	董新舒, 赵鹏, 于志伟, 等. 直肠癌术后局部复发形式及其治疗 [J]. 中国实用外科杂志, 2002, 22（6）: 334336.
11.	Ramesh H, Bedi MS, Sikora SS. Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients [J]. Ann Surg, 2006, 244(5): 835836.
12.	张晓鹏, 李洁. 直肠癌N分期相关影像学因素CT与病理对照研究 [J]. 中华放射学杂志, 2005, 39（8）: 842846.
13.	Rosman AS, Korsten MA. Metaanalysis comparing CT colonography, air contrast barium enema, and colonoscopy [J]. Am J Med, 2007, 120(3): 203210.
14.	姜军, 欧阳汉, 蒋力明. 影像学检查在直肠癌诊断与分期中的价值 [J]. 肿瘤学杂志, 2009, 15(1): 1016.
15.	翟鸣春, 靳二虎, 马大庆. CT与MRI在直肠癌诊断及术前分期中的价值 [J]. 国际医学放射学杂志, 2008, 731(5): 326328.
16.	Heriot AG, Grundy A, Kumar D. Preoperative staging of rectal carcinoma [J]. Br J Surg, 1999, 86(1): 1728.
17.	何炜, 余江, 朱正鹏, 等. 术前MSCT在直肠癌TNM分期中的应用价值 [J]. 广东医学, 2010, 31（7）: 829831.
18.	张淼, 陈克敏, 赵泽华, 等. 多层螺旋CT扫描在结肠癌术前分期中的应用 [J]. 中华放射学杂志, 2005, 39（5）: 505509．.

1. Thoeni RF. Colorectal cancer: crosssectional imaging for staging of primary tumor and detection of local recurrence [J]. AJR Am J Roentgenol, 1991, 156(5): 909915.
2. 禚洪庆, 周岩冰, 吕亮, 等. 直肠癌直肠系膜浸润程度的术前螺旋CT与术后病理对照研究 [J]. 中华外科杂志, 2009, 47（8）: 599602.
3. 汪晓东, 吴俊华, 宋欢, 等. 64排螺旋CT在直肠癌术前分期的诊断价值 [J]. 现代肿瘤医学, 2009, 17（7）: 12841287.
4. 万德森. 结直肠癌流行病学与预防 [J]. 中国中西医结合外科杂志, 2011, 17（1）: 37.
5. Pusztaszeri M, Matter M, Kuonen A, et al. Nodal staging in colorectal cancer: should distant lymph nodes be recovered in surgical specimens? [J]. Hum Pathol, 2009, 40(4): 552557.
6. 谢琦, 梁碧玲, 黄达德, 等. 结肠癌术前多层面CT一站式检查的临床价值 [J]. 世界华人消化杂志, 2007, 15（12）: 13821388.
7. 郁宝铭. 低位直肠癌的诊治进展 [J]. 中国实用外科杂志, 2002, 22（1）: 3437.
8. 杨强, 王劲松, 余正, 等. 直肠癌术后局部复发的预防和治疗 [J]. 重庆医学, 2009, 38（5）: 519520.
9. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery－the clue to pelvic recurrence? [J]. Br J Surg, 1982, 69(10): 613616.
10. 董新舒, 赵鹏, 于志伟, 等. 直肠癌术后局部复发形式及其治疗 [J]. 中国实用外科杂志, 2002, 22（6）: 334336.
11. Ramesh H, Bedi MS, Sikora SS. Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients [J]. Ann Surg, 2006, 244(5): 835836.
12. 张晓鹏, 李洁. 直肠癌N分期相关影像学因素CT与病理对照研究 [J]. 中华放射学杂志, 2005, 39（8）: 842846.
13. Rosman AS, Korsten MA. Metaanalysis comparing CT colonography, air contrast barium enema, and colonoscopy [J]. Am J Med, 2007, 120(3): 203210.
14. 姜军, 欧阳汉, 蒋力明. 影像学检查在直肠癌诊断与分期中的价值 [J]. 肿瘤学杂志, 2009, 15(1): 1016.
15. 翟鸣春, 靳二虎, 马大庆. CT与MRI在直肠癌诊断及术前分期中的价值 [J]. 国际医学放射学杂志, 2008, 731(5): 326328.
16. Heriot AG, Grundy A, Kumar D. Preoperative staging of rectal carcinoma [J]. Br J Surg, 1999, 86(1): 1728.
17. 何炜, 余江, 朱正鹏, 等. 术前MSCT在直肠癌TNM分期中的应用价值 [J]. 广东医学, 2010, 31（7）: 829831.
18. 张淼, 陈克敏, 赵泽华, 等. 多层螺旋CT扫描在结肠癌术前分期中的应用 [J]. 中华放射学杂志, 2005, 39（5）: 505509．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Rectum-Aerated MSCT for Preoperative Staging of Rectal Cancer

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