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[目的]探讨结直肠局部复发癌CT、MRI诊断要点。[方法]回顾分析经活检 ,再次手术病理证实 ,临床随访诊断的术后局部复发病例共67例的CT、MRI等资料。[结果]38例造瘘术后患者骶前手术床内软组织肿块形成 ,大多为团块状 ,边缘不规则。29例非造瘘术后患者吻合口处肠壁增厚 ,肠腔狭窄 ,肿块形成。直径为4cm～10cm ,较大肿块密度不均 ,中心坏死 ,边缘不规则 ,增强扫描肿块实质部分呈不规则强化。MRI表现为T1 低信号 ,T2 高信号 ,多数病例信号强度不均匀。邻近结构受累45例 ,其中合并区域淋巴结肿大21例 ,远处转移19例。[结论]CT、MRI检查对结直肠癌根治术后随访观察复发具有重要地位 ,它们能诊断具有典型形态特征的局部复发癌。但对小病灶的发现仍有一定的局限 ,对不典型复发灶的鉴别仍有困难。CT、MRI诊断关键在于区别局部纤维疤痕或可能合并的炎症组织与其内的复发灶。有否合并淋巴结肿大 ,邻近组织受累以及间隔4至6周的两次检查肿块增大有重要的诊断意义
[Objective] To investigate the main points of CT and MRI diagnosis of local recurrence of colorectal carcinoma. [Methods] Retrospective analysis of biopsy, re-surgical pathology confirmed, clinical follow-up diagnosis of postoperative local recurrence of a total of 67 cases of CT, MRI and other data. [Results] 38 cases of postoperative fistulas developed soft tissue masses in the presurgery bed, mostly lumps and irregular edges. 29 cases of non-osteotomy patients after anastomotic wall thickening of the intestine, intestinal lumen stenosis, mass formation. Diameter is 4cm ~ 10cm, the density of the larger tumor is uneven, the center of necrosis, the edge is irregular, and the substantial part of the enhanced scan mass is irregularly enhanced. MRI showed low T1 signal, high T2 signal, and uneven signal intensity in most cases. There were 45 cases of adjacent structures involved, of which 21 cases had regional lymphadenopathy and 19 cases had distant metastases. [Conclusion] CT and MRI examinations are important for the follow-up of recurrence after radical resection of colorectal cancer. They can diagnose local recurrence carcinomas with typical morphological features. However, there are still some limitations in the detection of small lesions, and there are still difficulties in the identification of atypical recurrent lesions. The key to the diagnosis of CT and MRI is to distinguish local fiber scars or possible inflammatory tissues and recurrences within them. Whether or not there is lymphadenopathy, involvement of adjacent tissues, and an increase in the size of the two examinations between 4 and 6 weeks have important diagnostic implications.