MSCT双对比剂充盈对胃癌TNM分期的诊断价值  

Diagnotic Value of MSCT with Two Oral Contrast Agents Filling Method in TNM Staging of Gastric Carcinoma

作　　者：王刚[1] 程雪[1] 王志铭[1] 雷振[1] 张祥林[1] 

机构地区：[1]辽宁医学院附属第一医院放射科,辽宁省锦州市121001

出　　处：《中国肿瘤临床》2009年第22期1266-1270,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨MSCT双对比剂充盈、三期增强结合三维重建在胃癌术前分期及评估中的应用价值。方法:对34例经胃镜活检证实的胃癌患者术前行MSCT平扫、三期动态增强扫描及三维重建扫描,再运用多平面重建、容积重建及CT仿真内窥镜等后处理技术,进行胃癌MSCT-TNM分期,并与手术病理分期结果相比较。结果:1)MSCT表现病灶厚度与手术病理的浆膜侵犯,淋巴结转移均相关(P<0.05);MSCT的强化特点与手术病理的淋巴结转移相关(P<0.05),与浆膜侵犯不相关。2)MSCT-TNM分期:MSCT对胃癌T、N、M分期的判断准确率分别为79.4%、75.6%和100%,其中对淋巴结转移的敏感性和特异性分别为73.9%和88.9%。MSCT对胃癌TNM临床分期判断的准确率为81.8%。结论:MSCT可在很大程度上提高微小病变的检出率,可对癌肿侵犯胃壁的深度、区域淋巴结转移情况、周围脏器浸润以及远处转移情况做出较为准确的判断,较准确的作出TNM分期。MSCT作为一种新型、无创、在体的评价手段,能较准确的对胃癌进行术前分期及评估,对指导临床治疗具有较大的临床应用价值。Objective： To explore the clinical value of MSCT in the preoperative staging and assessment of gastric carcinoma using two oral contrast agents filling method, triphase enhancement and three-dimensional reconstruction. Methods： Thirty-four patients with gastric carcinoma identified by gastroscopy underwent plain scanning, triphase enhancement scanning and three-dimensional reconstruction scanning. Then many kinds of post-processing technology including multi-planar reconstuction, volume rendering and CT virtual endoscopy were performed for TNM staging of gastric cancer through CT appearance. The results were compared with those of surgical pathologic findings. Results： （1） MSCT appearance： the thickness of gastric cancer lesions was correlated with serosal invasion and lymph node metastasis （P〈0.05）. The feature of MSCT enhancement of gastric cancer was correlated with lymph node metastasis （P〈0.05） but was not correlated with serosal invasion. （2） MSCT-TNM staging： the accuracy in T, N, and M stage of gastric carcinoma was 79.4%, 75.6%, and 100%, respectively. The sensitivity and specificity of lymph node metastasis of gastric carcinoma were 73.9% and 88.9%, respectively. The accuracy rate of TNM clinical stage determined with MSCT was 81.8%. Conclusion： MSCT can increase the detection rate of small focus of infection, with high accuracy in judgement of invasive depth and regional lymph node metastasis of gastric carcinoma, and the superiority in evaluating the distant metastases and the involvement of surrounding organs, resulting in accurate TNM staging. As a new, non-invasive means of examination in vivo, MSCT has great clinical value in the preoperative TNM staging and assessment and treatment of gastric carcinoma.

关 键 词：多层螺旋CT 胃肿瘤 三维显像 TNM分期 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]