腹部增强CT检查二维冠状面成像和三维血管重建对右半结肠癌关键血管的评估效果比较

Comparison in preoperative evaluation effects of abdominal enhanced CT two-dimensional coronal imaging versus three-dimensional vascular reconstruction for critical blood vessels in right colon cancer

    摘要
  • 摘要: 目的:比较腹部增强CT检查二维冠状面成像和三维血管重建对右半结肠癌关键血管的评估效果。
    方法:采用回顾性描述性研究方法。 收集2018年1—9月海军军医大学附属长海医院收治的50例右半结肠癌患者的临床病理资料；男33例，女17例；平均年龄为63岁，年龄范围为33～86岁。50例患者于同一台CT设备行腹部增强多排螺旋CT检查。每位患者CT检查数据均进行二维冠状面成像和三维血管重建。观察指标：(1)胃结肠干(Henle干)的解剖构成分型。(2)Henle干长度和外科干长度。(3)回结肠静脉和回结肠动脉走行关系。正态分布的计量资料以Mean±SD表示，计数资料以绝对数表示。采用Kappa系数评估二维冠状面成像图与三维血管重建图中Henle干解剖构成分型的一致性。采用Pearson系数评估Henle干长度和外科干长度在二维冠状面成像图与三维血管重建图的相关性。采用Bland-Altman图法评估Henle干长度和外科干长度在二维冠状面成像图与三维血管重建图的一致性。
    结果:(1)Henle干的解剖构成分型：50例患者的二维冠状面成像图中，发现Henle干43例，无Henle干7例。50例患者的三维血管重建图中，发现Henle干44例，无Henle干6例。43例二维冠状面成像图中发现Henle干0型、Ⅰ型、Ⅱ型、Ⅲ型分别为2、21、17、3例。44例三维血管重建图中发现Henle干0型、Ⅰ型、Ⅱ型、Ⅲ型分别为6、19、16、3例。两种成像方式观测同一病例Henle干的解剖构成分型相同的例数：无Henle干6例，0型2例，Ⅰ型18例，Ⅱ型15例，Ⅲ型3例。Henle干的解剖构成分型在二维冠状面成像图和三维血管重建图中的一致性好(κ=0.830，95%可信区间为0.705～0.956，P<0.05)。(2)50例患者的二维冠状面成像图中，43例发现Henle干，长度为(10±5)mm；42例发现外科干，长度为(34±12)mm。50例患者的三维血管重建图中，44例发现Henle干，长度为(9±5)mm；43例发现外科干，长度为(35±12)mm。Henle干长度和外科干长度的二维冠状面成像图与三维血管重建图呈正相关(r=0.872，0.979，P<0.05)。Bland-Altman图法结果显示：同一患者Henle干长度和外科干长度在二维冠状面成像图与三维血管重建图中均有高度一致性(P<0.05)。(3)回结肠静脉和回结肠动脉走行关系：50例患者中，二维冠状面成像图中回结肠静脉和回结肠动脉前交叉型24例，后交叉型26例；三维血管重建图中上述指标分别为24、26例。同一患者的回结肠动、静脉走行关系在二维冠状面成像图和三维血管重建图中完全一致。
    结论:腹部增强CT检查二维冠状面成像和三维血管重建评价右半结肠癌关键血管相对位置有相似的效果，一致性好。

     

    Abstract: Objective:To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.
    Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected. There were 33 males and 17 females, aged from 33 to 86 years, with an average age of 63 years. All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment. The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction. Observation indicators: (1) anatomical type of Henle trunk; (2) the length of Henle trunk and surgical trunk; (3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA). Measurement data with normal distribution were represented as Mean±SD, and count data were represented as absolute numbers. Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images. Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Bland-Altman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.
    Results:(1) Anatomical type of Henle trunk: on the 2D coronal images, 43 of 50 patients had the Henle trunk and 7 had no Henle trunk. On the 3D vascular reconstructed images, 44 of 50 patients had the Henle trunk and 6 had no Henle trunk. There were 2, 21, 17, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 2D coronal images of 43 patients. There were 6, 19, 16, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients. Six patients with no Henle trunk, 2 in type 0, 18 in type Ⅰ, 15 in type Ⅱ, and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images. The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ=0.830, 95% confidence interval: 0.705-0.956, P<0.05). (2) The length of Henle trunk and surgical trunk: on the 2D coronal images, 43 of 50 patients had the length of Henle trunk as (10±5)mm, and 42 of 50 patients had the length of surgical trunk as (34±12)mm. On the 3D vascular reconstructed images, 44 of 50 patients had the length of Henle trunk as (9±5)mm, and 43 of 50 patients had the length of surgical truck as (35±12)mm. The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872, 0.979, P<0.05). Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P<0.05). (3) The positional relationship between ICV and ICA: on the 2D coronal images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. On the 3D vascular reconstructed images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.
    Conclusion:Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer, with a good consistency.

     

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