Differential Diagnosis of Cecal Carcinoma and Inflammatory Lesions by Two-Phase Spiral CT

초록

목적:To evaluate the possibility of differential diagnosis between cecal carcinoma and inflammatory lesions by analyzing two-phase spiral CT features. 방법:We retrospectively reviewed fifty-nine cases of two-phase spiral CT scans (arterial and venous phase) from patients with wall thickening in their cecum and pericecal region including proximal ascending colon and terminal ileum. Our series included 35 cases of cecal carcinoma, 15 of tuberculosis, 6 of Crohn`s disease, and 3 of acute appendicitis. All of our series (n=59) were confirmed by histopathology. We evaluated the differential points between cecal carcinoma and inflammatory lesions. 결과:Mean wall thickness and length of involved segment were 18.1mm and 50.0mm in cecal carcinoma group, and were 12.4mm and 75.5mm in inflammatory lesion group, respectively. Twenty-one of 24 cases (87.5%) in inflammatory lesion group and 8 of 35 (22.9%) in cecal carcinoma group showed concentric wall thickening, and remainders showed eccentric thickening. Common enhancement patterns of cecal carcinoma group were 1) generalized homogeneous enhancement of all layer on both arterial and venous phase (19/35; 54.3%), 2) highly enhanced thick inner wall layer on arterial phase became generalized homogeneous enhancement on venous phase (14/35; 40.0%). Commonest enhancement pattern of inflammatory lesion group was highly enhanced thin inner wall layer with clearly distinguished three layers of colonic wall on both arterial and venous phase (12/24; 50%). Mean extent of pericecal fat infiltration from outer margin of thickened wall was 20.0mm in cecal carcinoma group and 28.0mm in inflammatory lesion group. The finding of pericecal fluid collection was more frequent in inflammatory lesion group than in cecal carcinoma group (62.5% vs. 17.1%). The incidence of regional lymph node enlargement was not significantly different between cecal carcinoma group and inflammatory lesion group (77.1% vs. 62.5%). 결론: Cecal carcinoma and