经直肠超声检查在直肠癌分期中的应用：灰阶、彩色血流及多普勒成像分析的作用

Transrectal sonography in staging rectal carcinoma: the role of gray-scale, color-flow, and Doppler imaging analysis.

作者信息

Heneghan J P, Salem R R, Lange R C, Taylor K J, Hammers L W

机构信息

Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT 06520-8042, USA.

出版信息

AJR Am J Roentgenol. 1997 Nov;169(5):1247-52. doi: 10.2214/ajr.169.5.9353436.

DOI:10.2214/ajr.169.5.9353436

PMID:9353436

Abstract

OBJECTIVE

The purpose of this study was to evaluate the efficacy of combining gray-scale sonography with color-flow imaging and pulsed Doppler transrectal sonography in the staging of rectal carcinoma.

SUBJECTS AND METHODS

Thirty-nine patients with primary rectal carcinoma underwent transrectal sonography. The rectal masses were staged T1-T2 or T3-T4 on the basis of gray-scale imaging. The local nodes were classified as benign or malignant on the basis of size and echogenicity. In 22 patients, color-flow imaging and pulsed Doppler imaging of the rectal mass and of the local lymph nodes were performed. The peak systolic velocity (PSV) and end diastolic velocity were documented, and the resistive index was calculated.

RESULTS

Gray-scale imaging alone was used to stage T1-T2 masses with 88% sensitivity and 82% specificity. T3-T4 masses were staged with 82% sensitivity and 88% specificity. Overall accuracy was 85%. Gray-scale imaging of lymph nodes using a discriminatory size of less than or equal to 5 mm for benign nodes and greater than 5 mm for malignant nodes yielded a sensitivity of 100%, a specificity of 28%, and an accuracy of 52%. Using receiver operating characteristic curve analysis, we determined that a size of greater than or equal to 7 mm was optimal for characterizing nodes. Such a size provided an accuracy of 83%. PSV of less than 25 cm/sec distinguished T3-T4 from T1-T2 rectal masses with 75% sensitivity, 80% specificity, and 77% accuracy. A PSV of greater than 20 cm/sec classified a node as malignant with 100% sensitivity, 62% specificity, and 76% accuracy. A resistive index of greater than 0.61 classified a node as malignant with 71% sensitivity, 85% specificity, and 80% accuracy.

CONCLUSION

Color-flow imaging and pulsed Doppler imaging are useful additions to gray-scale transrectal sonography in staging primary rectal carcinomas. The combination has most value when evaluating perirectal nodes.

摘要

目的

本研究旨在评估灰阶超声检查联合彩色血流成像及脉冲多普勒经直肠超声检查在直肠癌分期中的效能。

对象与方法

39例原发性直肠癌患者接受经直肠超声检查。根据灰阶成像将直肠肿块分为T1-T2期或T3-T4期。根据大小和回声将局部淋巴结分为良性或恶性。对22例患者进行了直肠肿块及局部淋巴结的彩色血流成像和脉冲多普勒成像检查。记录收缩期峰值流速（PSV）和舒张末期流速，并计算阻力指数。

结果

单纯灰阶成像对T1-T2期肿块分期的敏感度为88%，特异度为82%。对T3-T4期肿块分期的敏感度为82%，特异度为88%。总体准确率为85%。使用小于或等于5mm作为良性淋巴结的鉴别大小、大于5mm作为恶性淋巴结的鉴别大小进行淋巴结灰阶成像，敏感度为100%，特异度为28%，准确率为52%。采用受试者工作特征曲线分析，我们确定大于或等于7mm的大小最适合用于鉴别淋巴结。这样的大小准确率为83%。PSV小于25cm/秒区分T3-T4期与T1-T2期直肠肿块的敏感度为75%，特异度为80%，准确率为77%。PSV大于20cm/秒将淋巴结判定为恶性的敏感度为100%，特异度为62%，准确率为76%。阻力指数大于0.61将淋巴结判定为恶性的敏感度为71%，特异度为85%，准确率为80%。