Li Zhen-Hui, You Ding-Yun, Gao De-Pei, Yang Guang-Jun, Dong Xing-Xiang, Zhang Da-Fu, Ding Ying-Ying
Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming.
Department of Science and Technology, Kunming Medical University, Kunming, Yunnan, People's Republic of China.
Onco Targets Ther. 2017 Apr 26;10:2297-2303. doi: 10.2147/OTT.S131008. eCollection 2017.
Most colorectal cancers are classical adenocarcinomas (AC), and less frequent subtypes include mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC). The purpose of this study was to evaluate the computed tomography (CT) findings that can help to differentiate MAC and SC from AC.
CT scans of 168 patients with pathologically proven MAC and 67 patients with pathologically proven SC were analyzed, and 220 patients with classical AC were also included as a control group. CT findings of the three groups were compared and contrasted in terms of the bowel involvement patterns, contrast enhancement patterns, and presence or absence of bowel obstruction, intratumoral calcification, pericolic fat infiltration, and local tumor extension to adjacent organs. Statistical analyses were made by using the one-way analysis of variance, least significant difference test, and Pearson's chi-square test.
Compared with classical AC, the MAC showed more severe (6.29±2.69 cm vs 4.57±1.74 cm, <0.001) and higher percentage of occurrence of eccentric bowel-wall thickening (37.2% vs 11.5%, <0.001). Heterogeneous contrast enhancement was most common in MAC (<0.01), and MAC showed more areas with hypoattenuation (<0.001). The presence of intratumoral calcification was most frequent in MAC (17.9% vs 2% vs 6.8%) (<0.001); the SC also were more severe (5.75±2.28 cm vs 4.57±1.74 cm. =0.001) than AC, but SC tend to show more cases of concentric even bowel-wall thickening (67.2%); homogeneous contrast enhancement was most common in SC (<0.01), and it showed a target appearance. The presence of peritoneal seeding was most frequent in SC (35.8% vs 8% vs 2.7%, <0.001), while the presence of regional lymph node metastasis (=0.190) and direct invasion of adjacent organs or metastasis (=0.323) were not significantly different among them.
Some radiological features by CT can be used to classify different colon tumor types.
大多数结直肠癌是经典腺癌（AC），较少见的亚型包括黏液腺癌（MAC）和印戒细胞癌（SC）。本研究的目的是评估有助于将MAC和SC与AC区分开来的计算机断层扫描（CT）表现。
分析了168例经病理证实为MAC的患者和67例经病理证实为SC的患者的CT扫描结果，并纳入220例经典AC患者作为对照组。比较和对比了三组在肠受累模式、对比增强模式以及是否存在肠梗阻、肿瘤内钙化、结肠周围脂肪浸润和局部肿瘤向邻近器官扩展方面的CT表现。采用单因素方差分析、最小显著差异检验和Pearson卡方检验进行统计分析。
与经典AC相比，MAC表现出更严重的偏心肠壁增厚（6.29±2.69 cm对4.57±1.74 cm，<0.001）且发生率更高（37.2%对11.5%，<0.001）。不均匀对比增强在MAC中最为常见（<0.01），且MAC表现出更多低密度区域（<0.001）。肿瘤内钙化在MAC中最为常见（17.9%对2%对6.8%）（<0.001）；SC也比AC更严重（5.75±2.28 cm对4.57±1.74 cm，=0.001），但SC倾向于表现出更多同心性均匀肠壁增厚的病例（67.2%）；均匀对比增强在SC中最为常见（<0.01），且呈靶样表现。腹膜种植在SC中最为常见（35.8%对8%对2.7%，<0.001），而区域淋巴结转移（=0.190）和向邻近器官的直接侵犯或转移（=0.323）在它们之间无显著差异。
CT的一些影像学特征可用于对不同类型的结肠肿瘤进行分类。
