多层螺旋CT三期增强结合仿真内窥镜技术对进展期胃癌术前分期评估的应用研究  

Preoperative evaluation of advanced gastric carcinoma with MSCT triphase contrast enhancement combined with CTVE

作　　者：毛泽庆[1] 党雅梅[2] 黄刚[1] 徐香玖[1] 郭青[1] 崔兰兰[1] 

机构地区：[1]甘肃省人民医院放射科,甘肃兰州730000 [2]甘肃省人民医院病理科,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2007年第1期71-75,共5页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的 使用多层螺旋CT（MSCT）三期增强与仿真内窥镜（CTVE）技术相结合对进展期胃癌患者进行术前病理分期，探讨MSCT对进展期胃癌的术前评估价值。方法 对46例胃镜确诊的进展期胃癌患者进行术前充水增强三期MSCT检查，其中26例在增强之前先进行了胃充气平扫，比较CTVE与胃镜所见，探讨CTVE对进展期胃癌病灶的检出率；通过与手术后病理检查结果对照，比较5mm层厚横断面影像与1．25mm薄层横断面结合多平面重组（MPR）影像对术前肿瘤T分期和N分期评估的准确性。结果CTVE对26例进展期胃癌均检出，与胃镜检查结果一致。46例患者手术后病理检查T分期结果显示T2为24例，T3为13例，T4为9例，5mm层厚CT影像和薄层结合MPR影像检查结果与病理检查结果的符合率分别为63％和80％，两者具有显著性差异（X^2=4．083，P=0．039），1．25mm薄层结合MPR影像符合率高；N分期病理检查结果显示N0为21例，N1为14例，N2为6例，N3为5例，5mm层厚CT影像与薄层结合MPR影像下检查进展期胃癌的符合率分别为52％和57％，两者无显著性差异（X^2=0．071，P=0．791）。结论 MSCT薄层影像结合后处理技术MPR和CTVE对进展期胃癌的检出、术前分期具有很高的价值。Objective To study preoperative evaluation of advanced gastric carcinoma （AGC） with MSCT triphase contrast enhancement combined with CTVE, and compare with pathological results. Methods 46 cases underwent preoperative water filling MSCT triphase contrast enhancement, out of them, 26 cases underwent plain scan of filling gas first. The appearances under CTVE and gastroscopy were compared to investigate the detection rate of AGC by CTVE. The accuracy of preoperative tumor （T） and lymph node （N） staging was investigated by comparing 5 mm thickness layer axial images with 1.25 mm thickness layer axial images combined with multi-planar reformation （MPR）, and compared with the pathological examination results after operation. Results Detection rates of both CTVE and gastroscopy were the same in 26 cases; histopathological findings were respectively 24 of T2, 13 of T3, 9 of T4 and 21 of No, 14 of N1, 6 of N2 and 5 of N3 in 46 cases. The overall T staging accuracy of the axial and combined axial and MPR images was as follows： 63% versus 80% （X^2=4.083, P=0.039）. The overall N staging accuracy of the axial and combined axial and MPR images was as follows： 52% versus 57% （X^2=0.071, P=0.791）. Conclusion MSCT thin layer axial images combined with MPR and CTVE are much valuable in detecting, general typing, and preoperative staging of advanced gastric carcinoma.

关 键 词：多层螺旋CT 三期增强 仿真内窥镜 进展期胃癌 

分 类 号：R734.2[医药卫生—肿瘤]