Ng C S, Doyle T C, Pinto E M, Courtney H M, Bull R K, Prevost A T, Campbell G A, Freeman A H, Dixon A K
Department of Radiology, Addenbrooke's NHS Trust, University of Cambridge, UK.
Eur Radiol. 2002 Dec;12(12):2988-97. doi: 10.1007/s00330-002-1367-5. Epub 2002 May 8.
Frail and physically or mentally disabled patients frequently have difficulty in tolerating formal colonic investigations. The aims of this study were to evaluate the accuracy of minimal-preparation CT in identifying colorectal carcinoma in this population and to determine the clinical indications and radiological signs with the highest yield for tumour. The CT technique involved helical acquisition (10-mm collimation, 1.5 pitch) following 2 days of preparation with oral contrast medium only. The outcome of 4 years of experience was retrospectively reviewed. The gold standards were pathological and cancer registration records, together with colonoscopy and barium enema when undertaken, with a minimum of 15 months follow-up. One thousand seventy-seven CT studies in 1031 patients (median age 80 years) were evaluated. CT correctly identified 83 of the 98 colorectal carcinomas in this group but missed 15 cases; sensitivity and specificity (with 95% confidence interval) 85% (78-92%) and 91% (90-93%), respectively. Multivariate analysis identified: (a) a palpable abdominal mass and anaemia to be the strongest clinical indications, particularly in combination (p<0.0025); and (b) lesion width and blurring of the serosal margin of lesions to be associated with tumours (p<0.0001). Computed tomography has a valuable role in the investigation of frail and otherwise disabled patients with symptoms suspicious for a colonic neoplasm. Although interpretation can be difficult, the technique is able to exclude malignancy with good accuracy.
身体虚弱以及有身体或精神残疾的患者常常难以耐受常规的结肠检查。本研究的目的是评估低准备CT在该人群中识别结直肠癌的准确性，并确定肿瘤检出率最高的临床指征和放射学征象。CT技术包括仅在口服对比剂准备2天后进行螺旋扫描（准直10毫米，螺距1.5）。回顾性分析了4年的经验结果。金标准为病理和癌症登记记录，以及进行的结肠镜检查和钡灌肠检查，并至少随访15个月。对1031例患者（中位年龄80岁）的1077次CT检查进行了评估。CT正确识别出该组98例结直肠癌中的83例，但漏诊15例；敏感性和特异性（95%置信区间）分别为85%（78 - 92%）和91%（90 - 93%）。多变量分析确定：（a）可触及的腹部肿块和贫血是最强的临床指征，尤其是两者同时出现时（p<0.0025）；（b）病变宽度和病变浆膜边缘模糊与肿瘤相关（p<0.0001）。计算机断层扫描在对有结肠肿瘤可疑症状的身体虚弱及其他残疾患者的检查中具有重要作用。尽管解读可能困难，但该技术能够以较高的准确性排除恶性肿瘤。
