Abstract：Objective: To investigate the value of single source dual-energy CT monochromatic images in showing the rectal cancer peritoneal reflection. Methods: One hundred and five cases of rectal cancer patients with single source dual-energy CT scan and confirmed by pathology were retrospectively analyzed, the appearance of the peritoneal reflection on mixed energy image and 11 groups of monochromatic images(40~140 keV at intervals of 10 keV) were scored by two observers, the Kappa test was used to check the consistency of the score. The Mann-Whitney U test was used to compare the scores of mixed energy image and each monochromatic image. The relationship between rectal cancer and peritoneal reflection on mixed energy image and the highest score monochromatic image were compared with the surgery record, the Chi square test was used to compare the compliance rate. Results: The consistency of the image quality scores by the two observers were better or common. The 50~80 keV images’ quality scores were higher than mixed energy image(P<0.05), the 60 keV image score was the highest. The coincidence rate of the relationship between rectal cancer and peritoneal reflection on mixed energy image and 60 keV image were 80.95%, 89.52%, with significant difference(P<0.05). Conclusion: Single source dual-energy CT of 50~80 keV images displayed peritoneal reflection are better than mixed energy image, the best is 60 keV image, and it has certain clinical value.
田士峰，刘爱连，汪禾青，刘静红，孙美玉，马春梅，鞠 烨，刘义军. 单源双能CT单能量图像显示直肠癌腹膜返折的价值[J]. 中国临床医学影像杂志, 2016, 27(9): 644-648.
TIAN Shi-feng, LIU Ai-lian, WANG He-qing, LIU Jing-hong, SUN Mei-yu, MA Chun-mei, JU Ye, LIU Yi-jun. The value of single source dual-energy CT monochromatic images in showing the rectal cancer peritoneal reflection. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(9): 644-648.
[1]Finlay I. Preoperative staging for rectal cancer[J]. BJM, 2006, 333(7572): 766-767.
[2]Sato H, Maeda K, Maruta M, et al. Who can get the beneficial effect from lateral lymph node dissection for Dukes C rectal carcinoma below the peritoneal reflection?[J]. Dis Colon Rectum, 2006, 49(10 Suppl): S3-S12.
[3]Tang L, Zhang XP, Sun YS, et al. Spectral CT in the demonstration of the gastrocolic ligament: a comparison study[J]. Surg Radiol Anat, 2013, 35(6): 539-545.
[4]Hu D, Yu T, Duan X, et al. Determination of the optimal energy level in spectral CT imaging for displaying abdominal vessels in pediatric patients[J]. Eur J Radiol, 2014, 83(3): 589-594.
[5]张茜，刘影. 直肠癌患者及健康人群直肠及周围解剖结构的高分辨MRI观察[J]. 中华解剖与临床杂志，2014，19（2）：97-101.
[6]Rosenberg R, Maak M, Schuster T, et al. Does a rectal cancer of the upper third behave more like a colon or a rectal cancer?[J]. Dis Colon Rectum, 2010, 53(5): 761-770.
[7]董新舒，徐海涛，张云斌. 腹膜返折以下直肠癌保肛手术的适应证和相关问题[J]. 肿瘤学杂志，2006，12（1）：23-26.
[8]王崇树，王城. 直肠癌术式进展及评价[J]. 川北学院学报，2008，23（4）：335-339.
[9]Liu YL, Wang YH, Yang YM, et al. The role of para-aortic lymphadenectomy in surgical management of patients with stage N+ rectal cancer below the peritoneal reflection[J]. Cell Biochem Biophys, 2012, 62(1): 41-56.
[10]Jung EJ, Ryu CG, Kim G, et al. Is rectal MRI beneficial for determining the location of rectal cancer with respect to the peritoneal reflection?[J]. Radiol Oncol, 2012, 46(4): 296-301.
[11]陈紫千，曹文新，刘蕾，等. 直肠癌与腹膜返折位置相关的MRI 表现分析[J]. 外科理论与实践，2013，18（5）：446-449.
[12]Zhao LQ, He W, Li JY, et al. Improving image quality in portal venography with spectral CT imaging[J]. Eur J Radiol, 2012, 81(8): 1677-1681.
[13]Desiree E. Dual-energy CT of the abdomen[J]. Abdom Imaging, 2014, 39(1): 108-134.
[14]Otrakji A, Digumarthy SR, Lo Gullo R, et al. Dual-Energy CT: Spectrum of Thoracic Abnormalities[J]. Radiographics, 2016, 36(1): 38-52.
[15]Agrawal MD, Pinho DF, Kulkarni NM, et al. Oncologic Applications of Dual-Energy CT in the Abdomen[J]. RadioGraphics, 2014, 34(3): 589-612.
[16]Brook OR, Gourtsoyianni S, Brook A, et al. Split-bolus spectral multidetector CT of the pancreas: assessment of radiation dose and tumor conspicuity[J]. Radiology, 2013, 269(1): 139-148.
2016, Vol. 27 
