Summers Ronald M, Huang Adam, Yao Jianhua, Campbell Shannon R, Dempsey Jennifer E, Dwyer Andrew J, Franaszek Marek, Brickman Danny S, Bitter Ingmar, Petrick Nicholas, Hara Amy K
Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, Room 1C351, 10 Center Dr. MSC 1182, Bethesda, MD 20892-1182, USA.
Acad Radiol. 2006 Dec;13(12):1490-5. doi: 10.1016/j.acra.2006.09.051.
We sought to demonstrate that intravenous contrast-enhanced CT colonography (CTC) can distinguish colonic adenomas from carcinomas.
Supine intravenous contrast-enhanced CTC with colonoscopic and/or surgical correlation was performed on 25 patients with colonic adenomas or carcinomas. Standard deviation of mean polyp CT attenuation was computed and assessed using ANOVA and receiver-operating characteristic analyses.
Colonoscopy confirmed 32 polyps or masses 1 to 8 cm in size. The standard deviations of CT attenuation were carcinomas (n = 13; 36 +/- 6 HU; range 28-48 HU) and adenomas (n = 19; 49 +/- 14 HU; range 31-100 HU) (P = 0.005). At a standard deviation threshold of 42 HU, the sensitivity and specificity for classifying a polyp or mass as a carcinoma were 92% and 79%, respectively. The area under the receiver-operating characteristic curve was 0.89 +/- 0.06 (95% confidence interval 0.73-0.96).
Measurement of the standard deviation of CT attenuation on intravenous contrast-enhanced CTC permits histopathologic classification of polyps 1 cm or larger as carcinomas versus adenomas. The presence of ulceration or absence of muscular invasion in carcinomas creates overlap with adenomas, reducing the specificity of carcinoma classification.
我们试图证明静脉注射对比剂增强的CT结肠成像（CTC）能够区分结肠腺瘤与癌。
对25例患有结肠腺瘤或癌的患者进行仰卧位静脉注射对比剂增强的CTC检查，并与结肠镜检查和/或手术结果进行对照。计算息肉平均CT衰减的标准差，并使用方差分析和受试者操作特征分析进行评估。
结肠镜检查证实有32个大小为1至8厘米的息肉或肿块。CT衰减的标准差在癌（n = 13；36±6 HU；范围28 - 48 HU）和腺瘤（n = 19；49±14 HU；范围31 - 100 HU）之间（P = 0.005）。在标准差阈值为42 HU时，将息肉或肿块分类为癌的敏感性和特异性分别为92%和79%。受试者操作特征曲线下面积为0.89±0.06（95%置信区间0.73 - 0.96）。
静脉注射对比剂增强的CTC上CT衰减标准差的测量能够对1厘米或更大的息肉进行组织病理学分类，区分癌与腺瘤。癌中溃疡的存在或无肌层浸润与腺瘤存在重叠，降低了癌分类的特异性。
