Lassau N, Leclère J, Elias D, Lasser P
Département d'Imagerie, Institut Gustave Roussy, Villejuif.
J Chir (Paris). 1997 Jul;134(2):51-8.
The imaging techniques used to follow-up patients submitted to surgery for colorectal cancers are presented as are their advantages and disadvantages. The sensitivity of ultrasonography (US) for postoperative surveillance of the liver varies considerably according to whether the absence or presence of metastases is sought (83%) or their exact number (53-82%). US is recommended by French clinicians as the standard follow-up examination whereas, American clinicians tend to discuss CT-Scan or MRI for the same purpose. Some authors advocate Doppler ultrasonography for the detection of liver metastases. Spiral CT-Scan offers better results than conventional CT and is now considered second in rank to US for follow-up studies. Its sensitivity exceeds 90% for metastases greater than 1 cm. IRM and arterial CT-scan are not applicable for follow-up but are sometimes indicated for difficult cases before hepatectomy. US is also an appropriate technique for postoperative exploration of the abdominal cavity. When the CEA level and the US examination are normal, this technique is sufficient. However, in dubious clinical or biological cases, US should be associated with a spiral CT-Scan. Most clinicians recommend a reference CT-Scan, two to four months after the resection and every 6 months for 2 years and then annually. The same follow-up strategy is advocated after abdominoperineal resection and for surveillance of the pelvis. The sensitivity of CT-Scan is between 69 and 88% but it is unable to differentiate recurrence from fibrosis. IRM, with a sensitivity of 90%, is the best method for overcoming with problems related to the differential diagnosis and particularly novel fast acquisition imaging and contrast agents. Ultrasonoendoscopy, repeated every 4 to 6 months after anterior resection, is also a useful examination for surveillance of the pelvis. PET-Scan has produced encouraging results for the detection of metastases and for the differential diagnosis between local recurrence and fibrosis. When available, this technique could become the "gold standard" for the surveillance of patients following surgery for colorectal cancers.
介绍了用于接受结直肠癌手术患者随访的成像技术及其优缺点。超声检查（US）对肝脏术后监测的敏感性根据是否寻找转移灶（83%）或转移灶的确切数量（53 - 82%）而有很大差异。法国临床医生推荐US作为标准的随访检查，而美国临床医生倾向于讨论使用CT扫描或MRI进行同样目的的检查。一些作者主张用多普勒超声检查来检测肝转移。螺旋CT扫描比传统CT效果更好，目前在随访研究中被认为仅次于US。对于大于1厘米的转移灶，其敏感性超过90%。磁共振成像（IRM）和动脉CT扫描不适用于随访，但在肝切除术前的疑难病例中有时会用到。US也是术后腹腔探查的合适技术。当癌胚抗原（CEA）水平和US检查正常时，该技术就足够了。然而，在临床或生物学情况可疑时，US应与螺旋CT扫描联合使用。大多数临床医生建议在切除术后两到四个月进行一次参考CT扫描，接下来两年每6个月进行一次，然后每年一次。腹会阴切除术后以及盆腔监测也提倡同样的随访策略。CT扫描的敏感性在69%至88%之间，但它无法区分复发和纤维化。IRM的敏感性为90%，是克服鉴别诊断相关问题的最佳方法，尤其是新型快速采集成像和造影剂。前切除术后每4至6个月重复一次的超声内镜检查也是盆腔监测的有用检查。正电子发射断层扫描（PET - Scan）在转移灶检测以及局部复发和纤维化的鉴别诊断方面取得了令人鼓舞的结果。如果可行，该技术可能成为结直肠癌手术后患者监测的“金标准”。
