Abstract: Objective　To investigate the value of multi-slice spiral computed tomography (MSCT) in diagnosing T-stage and N-stage of colorectal cancer (CRC) before surgery. Methods　This was a retrospective study. A total of 73 pathology-confirmed colorectal cancer patients scheduled for surgery in Affiliated Hospital of Yangzhou University and Yangzhou Hospital of Traditional Chinese Medicine were retrospectively included from January 2018 to December 2020, including 48 males and 25 females, aged (65.3±10.8) years. All patients underwent triphasic contrast-enhanced MSCT examination before surgery. Two experienced radiologists blindly reviewed the CT images, and CT based TN stages were determined in consensus. The accuracy of CT based TN staging was analyzed with a Kappa consistency test, with the postoperative pathology as reference standard. The count data were tested by χ² test. Results　The overall diagnostic accuracy of preoperative T stage was 91.78% (67/73), including 84.61% (11/13) for T_1-2, 93.55% (29/31) for T₃, and 93.10% (27/29) for T₄, and the diagnostic accuracy of T₃ and T₄ was significantly higher than that of T_1-2, with a statistically significant difference (χ²=5.24, P<0.05). The Kappa value of the consistency test between CT T staging and pathological staging was 0.869, indicating a very good consistency between the two. The overall diagnostic accuracy of preoperative N stage was 73.97% (54/73), which was significantly lower than that of T stage; the diagnostic accuracy was 65.62% (21/32) for N₀, 79.17% (19/24) for N₁, and 82.35% (14/17) for N₂; the diagnostic accuracy of N₀ was significantly lower than that of N₁ and N₂, with a statistically significant difference (χ²=6.72, P<0.05). The Kappa value of the consistency test between CT N staging and pathological staging was 0.611, indicating a good consistency between the two. Conclusions　Application of multi-phase contrast-enhanced MSCT can improve the diagnostic performance in diagnosing TN-stage for colorectal cancer patients before surgery, and provide valuable reference evidences in performing suitable planning for colorectal cancer patients in the clinical setting.

Key words: Colorectal cancer, MSCT, TN staging

摘要： 目的　探讨多层螺旋CT（MSCT）在结直肠癌术前TN分期中的诊断价值。方法　回顾性分析，收集2018年1月至2020年12月在扬州市中医院及扬州大学附属医院收治的拟行结直肠癌手术患者73例，其中男48例、女25例，年龄（65.3±10.8）岁，所有患者术前均行MSCT全腹部多期增强扫描，并由2名有经验的影像科副主任医师共同分析患者MSCT影像资料，得出术前CT TN分期诊断结论。以手术后病理结果为评判标准，评价术前MSCT对结直肠癌的诊断准确率。采用Kappa一致性检验研究MSCT的准确性；计数资料采用χ²检验。结果　术前T期诊断总准确率为91.78%（67/73），其中T_1～2期的准确率为84.61%（11/13），T₃期准确率为93.55%（29/31），T₄期诊断准确率为93.10%（27/29），T₃及T₄期诊断准确率明显高于T_1～2期，差异有统计学意义（χ²=5.24，P<0.05）。CT T分期与病理分期一致性检验Kappa值为0.869，这说明二者一致性非常好。术前N分期诊断总准确率为73.97%（54/73），准确率与T期相比明显较低；其中N₀期准确率为65.62%（21/32），N₁期为79.17%（19/24），N₂期为82.35%（14/17），N₀期准确率明显低于N₁、N₂期，差异有统计学意义（χ²=6.72，P<0.05）。CT N分期与病理分期一致性检验Kappa值为0.611，这说明二者一致性较好。结论　MSCT多期增强的应用能够提高结直肠癌患者的术前TN分期诊断准确率，为临床后续诊疗方案的选择提供有价值的参考依据。

关键词: 结直肠癌,  , MSCT, TN分期