早期胃癌的诊断:轴位与MPR的对照研究  

The Diagnosis of Early Gastric Cancer:Comparison of Transverse and MPR CT Images

作　　者：许玲辉[1] 吴坚[1] 钱敏[1] 徐黎明[1] 胡晓欣[1] 刘晓航[1] 彭卫军[1] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《当代医学》2010年第8期17-21,共5页Contemporary Medicine

摘　　要：目的评价水充盈法MDCT的MPR重建技术在早期胃癌中的诊断价值。方法回顾性分析28例经手术病理证实的早期胃癌,术前采用水充盈法MDCT腹部动脉期、门脉期双期增强扫描,随后1.5mm层厚,1mm间隔薄层重建结合多平面容积重建技术(MPR),评价MPR对早期胃癌的检出率及T分期的准确性并与5mm薄层轴位图像比较,结果与病理对照。结果 (1)早期胃癌的MPR检出率为86%(24/28),T分期准确率为75%(21/28);5mm薄层轴位图像为32%(9/28),T分期准确率为29%(8/28)。两者在早期胃癌的检出率及T分期准确率上的差异均有统计学意义(P<0.05)。(2)28例早期胃癌MDCT表现:①18例胃病变区显示多层结构,其特征性表现为不规则增厚、强化的胃壁伴溃疡,代表粘膜下层的低密度带存在且不强化(15/18);不典型表现为代表粘膜下层的低密度带有强化(2/18)。②10例胃病变区显示单层结构,其常见表现为胃壁局限性隆起性病灶(3/10);胃壁略见增厚伴溃疡(3/10);不常见表现为胃壁略僵,壁增厚不明显伴或不伴粘膜面不规则(3/10);以及胃壁未见明显异常(1/10)。③胃壁显示多层结构时,病灶区强化方式常表现为病灶区动脉期强化较门脉期明显(12/18),其次为病灶区门脉期强化较动脉期明显(6/18);胃壁仅显示单层结构时,病变区常表现为与正常胃壁同步强化(7/10)或动脉期强化较门脉期明显(3/10)。结论 MDCT的MPR重建技术能够提高早期胃癌的检出率及T分期的准确性。Objective Evaluate the utility of MDCT with a thin-sliced multiplanar reconstruction （MPR） technique and waterfilling method for the diagnosis of early gastric cancer. Methods Twenty-eight patients with early gastric cancers were preoperatively examined with MDCT using the water-filling method and analyzed retrospectively. The abdomen was dynamically scanned at arterial phase, venous phase dual-phase enhanced scanning. MPR images were reconstructed with a slice width of 1.5 mm and a slice interval of 1 mm. The detection rate and accuracy of T staging for early gastric cancer were evaluated on MPR images and compared with 5-mm-slice axial images. In addition, MDCT images were correlated with pathologic findings. Results （l）The detection rate of early gastric cancer using the MPR technique was 86% （24/28）, T staging accuracy rate was 75% （21/28）; 5mm thin axial images was 32% （9/28）, 29% （8/28） respectively. There was a statistically significant difference （P〈0.05） in the detection rate and accuracy of T staging of early gastric cancers between MPR and 5-mm-slice axial images. （2）Image analysis： （1） 18 cases showed gastric wall as three layer structure on MDCT. Typical appearance showed focal irregular enhancing wall thickening with ulceration, and intact lowattenuation strip representing the submucosal layer which had unenhancd （15/18）; or a lowattenuation strip representing the submucosal layer had enhanced （2/18）（2） 10 cases showed gastric wall as single-layer structure （3/10）; Typical imaging showed protruding mass （3/10）, or focal thickening with ulceration （3/10）; Unusual imaging showed no obvious wall thickening, slightly stiff with or without irregular mucosal surface （3/10） or no obvious abnormality in the stomach （1/10）.（3）When gastric wall showed three-layer structure, The most common enhanced patter of lesion was more stronger in arterial phase than venous phase （12/18）. Second patter was more stronger in venous phase than

关 键 词：胃肿瘤 T分期 多层螺旋CT 

分 类 号：R735.2[医药卫生—肿瘤]