Nomura Kazuhiko, Kadoya Masumi, Ueda Kazuhiko, Fujinaga Yasunari, Miwa Shiro, Miyagawa Shin-ichi
Department of Gastroenterological Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan.
J Clin Gastroenterol. 2007 Sep;41(8):789-95. doi: 10.1097/01.mcg.0000225676.22218.08.
The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers.
MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination.
Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS.
CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.
基于对切除肝脏的组织病理学检查，评估静脉增强多排螺旋计算机断层扫描（MDCT）、超顺磁性氧化铁增强磁共振成像（SPIO-MRI）、动脉门静脉造影联合肝动脉造影多排螺旋计算机断层扫描（CTAP/CTHA）以及术中超声检查（IOUS）对检测结直肠癌肝转移的特异性和敏感性。
对结直肠癌肝转移患者常规进行MDCT、SPIO-MRI、CTAP/CTHA和IOUS检查，以确定手术指征和方法。然后将切除的肝脏标本连续切成3至5毫米厚的切片进行常规组织学检查。
通过对8例结直肠癌肝转移患者大量解剖切除肝脏的组织病理学研究，检测到50个转移病灶。肿瘤大小从3毫米至53毫米不等（平均13.8毫米），26个病灶（52%）直径小于10毫米。对切除肝脏标本的组织病理学检查显示，CTAP/CTHA是最敏感的成像方式，其次依次为IOUS、SPIO-MRI和MDCT。在CTAP/CTHA检测到的所有肿瘤中，SPIO-MRI漏诊了5个，但SPIO-MRI检测到的所有肿瘤也被CTAP/CTHA检测到。MDCT、SPIO-MRI和组织病理学检查检测到的肝转移瘤数量差异显著。IOUS检测到1个假阳性病灶。
CTAP/CTHA是检测结直肠癌小肝转移的一种有用的术前成像方式。
