结肠黏液腺癌与结肠淋巴瘤的临床及CT鉴别诊断

Clinical and computed tomography differential diagnosis of colonic mucinous adenocarcinoma and colonic lymphoma

摘要:

目的：探讨结肠黏液腺癌与结肠淋巴瘤的临床及CT鉴别诊断，以提高术前诊断准确性。方法：回顾性分析经病理证实的57例结肠黏液腺癌与18例结肠淋巴瘤患者的临床及CT影像学资料，比较两者之间的差异。结果：黏液腺癌组强化率（ΔR1、ΔR2、ΔR3）、周围脂肪间隙模糊比率均高于淋巴瘤组（P＜0.05）；淋巴瘤组病灶实性部分平扫密度、平扫及增强均匀性、淋巴结肿大比率、肠套叠比率均高于黏液腺癌组（P＜0.05）。黏液腺癌有6例经临床随访确诊肝转移，1例肠穿孔伴脓腔形成；1例腰大肌浸润。2组病例年龄、性别、临床症状、病变部位、肠壁增厚形态、增强各期CT值、肠系膜腹膜受累、肠梗阻及腹腔积液发生率等均无统计学差异（P＞0.05）。结论：病变均匀性、实性部分平扫密度、强化率、侵袭性、肝转移及肠套叠等对结肠黏液腺癌及结肠淋巴瘤具有鉴别诊断意义。

Abstract:

Objective：To investigate the clinical and computed tomography（CT） differential diagnosis of colonic mucinous adenocar－cinoma and colonic lymphoma，and to improve the accuracy of preoperative diagnosis. Methods：A retrospective analysis was per－formed for the clinical and CT imaging data of 57 patients with pathologically confirmed colonic mucinous adenocarcinoma and 18 patients with pathologically confirmed colonic lymphoma. Results：Compared with the lymphoma group，the mucinous adenocarcino－ma group had significantly higher enhancement rate（ΔR1，ΔR2，and ΔR3） and rate of blurry fatty space（P<0.05）. Compared with the mucinous adenocarcinoma group，the lymphoma group had significantly higher plain scan density of the solid portion of the lesion，homogeneity of tumor during plain scan and contrast-enhanced scan，and proportion of patients with lymphadenectasis and intus－susception（P<0.05）. Among the patients with colonic mucinous adenocarcinoma，6 were found to have hepatic metastasis during follow-up，1 had intestinal perforation with abscess，and 1 had psoas major invasion. There were no significant differences between the two groups in age，sex，clinical symptoms，the location of tumor，shape of bowel wall-thickening，CT values in each enhancement phase，mesenteric and peritoneal involvement，and incidence rates of ileus and peritoneal effusion（P>0.05）. Conclusion：The homogeneity of tumor，plain scan density of the solid portion of the lesion，enhancement rate，invasiveness of tumor，hepatic metastasis，and intussusception may help with the differential diagnosis of colonic mucinous adenocarcinoma and colonic lymphoma.