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膀胱癌的CT及MRI临床诊断分析*

作者:王 斌 陶佳意

所属单位:湖北省黄冈市中心医院泌尿外科(湖北 黄冈 438000)

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摘要

目的 探析CT及MRI检查在膀胱 癌临床分期中的诊断价值。方法 选取我 院2012年6月-2014年6月经临床病理确诊 的59例膀胱癌患者作为研究对象,均行CT 与MRI诊断,对比CT和MRI诊断膀胱癌分 期的准确率及影像学表现。结果 以临床 病理为“金标准”,MRI诊断准确性、特 异性分别为93.22%、94.29%显著高于CT 的69.49%、65.71%(P<0.05)。CT上病灶 呈菜花状、乳头状、丘地状,为等密度或 稍高密度,部分可见钙化组织;增强扫描 显示不同程度强化,延迟扫描以充盈缺损 为主。MRI显示腔内型T1等信号,T2高信 号,浸润型和腔外型T2上局部膀胱壁信号 带连续性欠佳。17例增强扫描显示均存在 不同程度的强化。结论 MRI诊断膀胱癌分 期的准确性较高,对临床确定手术方案具 有指导意义。

Objective To explore the diagnostic value of CT and MRI in the clinical staging of bladder cancer. Methods 59 cases of patients with bladder cancer confirmed by clinical pathology in our hospital from June 2012 to June 2014 were selected as the research object. All underwent CT and MRI diagnosis. The accuracy of CT and MRI in the diagnosis of bladder cancer staging and the imaging findings were compared. Results With clinical pathology as the golden standard, the diagnostic accuracy and specificity of MRI (93.22%, 94.29%) were significantly higher those of CT (69.49%, 65.71%) (P<0.05). CT showed that the lesions were cauliflower-like, papillary and dune-like, which showed equal or slightly high density, with partially visible calcification; The enhanced scan showed different degrees of enhancement and the delayed scan was mainly filling-defect. MRI showed intraluminal type equal signal on T1 and high signal on T2. For infiltrating type and exogastric type, the signal area in local bladder wall was with poor continuity on T2. The enhancement of 17 cases showed different degrees of enhancement. Conclusion The accuracy of MRI in diagnosis of bladder cancer staging is high, which is of guiding significance for the establishment of clinical surgical treatment

【关键词】膀胱癌;CT;MRI;临床分期;影像学表现

【中图分类号】R737.14

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.06.029

前言

膀胱癌是泌尿系统中较为常见的恶性肿瘤之一,具有发病率高、 恶性程度高、预后差的特点[1]。手术是临床治疗膀胱癌的有效方式, 若肿瘤仅局限于粘膜等,建议术中保留膀胱;若侵犯肌层,建议行根 治术治疗[2]。因此,术前明确肿瘤分期、浸润深度、淋巴结转移情况 等对临床确定手术方案意义。CT、MRI等影像学是临床诊断膀胱癌的重 要方式,有利于提高术前分期的准确率;但CT与MRI对比诊断膀胱癌术 前分期研究的报道还相对较少。本文分析了我院收治的经临床病理确 诊为膀胱癌患者临床资料,探讨CT与MRI诊断膀胱癌、术前分期的准确 性及影像学表现,现报道如下。