Caseiro-Alves F, Gonçalo M, Cruz L, Ilharco J, Leite J, Agostinho A, Castro e Sousa F, Vilaça-Ramos H
Serviço de Radiologia, Hospital Universidade de Coimbra, Portugal.
Abdom Imaging. 1998 Jul-Aug;23(4):370-4. doi: 10.1007/s002619900363.
To determine the accuracy of computed tomography performed with a water enema application (WE-CT) in the local staging of low colorectal neoplasms and to compare the results with those of transrectal ultrasonography (TRUS).
Forty patients with low colorectal tumors were evaluated prospectively by CT with the simultaneous administration of a lukewarm rectal enema (0.5-1.5 L). Thin slices (5 mm) and intravenous application of iodinated contrast media were routinely used. TRUS was performed in 18 patients. Tumor size, location, and staging according to the TNM classification of the UICC were registered. Tumors were classified as < T3 (T1 or T2) or as T3 or T4. For staging peritumoral lymph node metastases on WE-CT, two criteria of positivity were tested: N+ if at least one peritumoral node > or 5 mm in diameter was seen (reading A); N+ if at least one peritumoral node > or = 5 mm or three peritumoral nodes < 5 mm were identified (reading B).
For the tumor staging, WE-CT showed a sensitivity of 90%, a specificity of 73%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 73%, and an accuracy of 85%. For TRUS, the results were sensitivity of 73%, specificity of 29%, PPV of 62%, NPV of 40%, and an accuracy of 39%. Concerning nodal staging with WE-CT, results were superior when reading A was used: sensitivity = 84%, specificity = 83%, PPV = 73%, NPV = 91%, and accuracy = 84%. TRUS showed a sensitivity of 29%, specificity of 100%, PPV of 100%, NPV of 67%, and an accuracy of 71%.
WE-CT is a reliable technique for the local staging of low colorectal tumors that can be superior to TRUS. For diagnosis of peritumoral metastatic lymph nodes on WE-CT, the 5-mm diameter cutoff value is the most appropriate size criterion.
确定水灌肠CT（WE-CT）在低位结直肠肿瘤局部分期中的准确性，并将结果与经直肠超声检查（TRUS）的结果进行比较。
对40例低位结直肠肿瘤患者进行前瞻性评估，采用CT同时给予温直肠灌肠（0.5-1.5L）。常规使用薄层（5mm）扫描并静脉注射碘化造影剂。18例患者进行了TRUS检查。记录肿瘤大小、位置以及根据国际抗癌联盟（UICC）的TNM分类进行的分期。肿瘤分为<T3（T1或T2）或T3或T4。对于WE-CT上肿瘤周围淋巴结转移的分期，测试了两种阳性标准：如果看到至少一个肿瘤周围淋巴结直径>或=5mm，则为N+（解读A）；如果识别出至少一个肿瘤周围淋巴结>或=5mm或三个肿瘤周围淋巴结<5mm，则为N+（解读B）。
对于肿瘤分期，WE-CT显示敏感性为90%，特异性为73%，阳性预测值（PPV）为90%，阴性预测值（NPV）为73%，准确性为85%。对于TRUS，结果为敏感性73%，特异性29%，PPV为62%，NPV为40%，准确性为39%。关于WE-CT的淋巴结分期，使用解读A时结果更佳：敏感性=84%，特异性=83%，PPV=73%，NPV=91%，准确性=84%。TRUS显示敏感性为29%，特异性为100%，PPV为100%，NPV为
