多层螺旋CT多平面重组对进展期胃癌毗邻器官侵犯的评价  

Evaluating adjacent organ invasion of advanced gastric cancer with multiplanar reformations of multi-slice CT

作　　者：刘特 朱进 陈杰[2] 龚静山[2] 杨雪菲[2] 胡海军[2] 潘凯[2] 徐坚民 

机构地区：[1]广东省深圳市人民医院(暨南大学第二临床医学院)放射科,广东深圳518020 [2]广东省深圳市人民医院(暨南大学第二临床医学院)胃肠外科,广东深圳518020

出　　处：《医学影像学杂志》2011年第2期213-217,共5页Journal of Medical Imaging

基　　金：深圳市科技计划项目(编号:200902001);深圳市医学重点学科建设基金资助(编号:2001B07)

摘　　要：目的：回顾性分析多层螺旋CT多平面重组（MPR）对进展期胃癌侵犯毗邻组织器官的评价。方法：此次回顾性研究得到医院道德与伦理委员会的准许并豁免知情同意。40例经手术病理证实的T3、T4期胃癌且在我院采用多层螺旋CT经服产气粉和水（500-1000ml）充分扩张胃后行低张动态增强扫描的患者入选此次研究。由两名经验丰富的放射诊断医生分别依据横断位及MPR图像通过协商对肿瘤病灶的显示和肿瘤对邻近器官的侵犯进行回顾性分析及侵犯范围的评估并经协商一致。采用McNemar检验比较横断图像和MPR图像对显示原发肿瘤侵犯邻近器官的准确性有无差别,P〈0.05认为有统计学意义。结果：MPR图像对40名进展期胃癌患者T分期的准确率是90.00%（36/40）,显著高于横断位图像的67.50%（27/40）（P=0.004）。MPR和横断位对胃癌T4期（胃癌灶对邻近器官侵犯）诊断的敏感性分别为83.33%和44.44%、特异性分别为95.45%和86.36%,MPR显示邻近器官侵犯范围优于横断位图像。结论：较之轴位CT图像,多层螺旋CT的MPR图像能提高胃癌对胃周邻近组织器官局部侵犯检测的准确性,提供更多的胃癌灶与毗邻器官解剖关系的信息。Objective：The purpose of this study was to retrospectively evaluate the role of multiplanar reformation（MPR） images of multi-detector row computed tomography（MDCT） in evaluating local organ invasion of advanced gastric cancers.Methods：The institutional review board approved this retrospective study and waived informed consent.Forty patients with surgical confirmed T3 or T4 gastric cancer were included in this study.Two experienced diagnostic radiologists assessed whether there was adjacent organ invasion on transverse images and MPRs of dynamic enhanced CT,respectively.The disagreement was set down by consensus.Difference in accuracy of transverse images and MPRs in assessment of adjacent organ invasion was assessed with the McNemar exact test.Statistical significance was inferred at P〈0.05.Results：To forty advanced gastric cancers,MPRs and transverse images showed a sensitivity of 83.33% VS 44.44%,a specificity of 95.45% VS 86.36% in differentiating T4 from T3,respectively.The accuracy for MPRs in assessment of adjacent organ invasion（differentiating T4 from T3） was 90.00%（36 of 40）,which was higher than that for transverse images（67.50%（27 of 40））（P=0.004）.MPRs had an advantage in assessing adjacent structures invasion.Conclusion：Comparing transverse images,MPRs of multi slice spiral CT can improve the accuracy of adjacent organ invasion of advanced gastric cancer and provide more information for operations.

关 键 词：胃癌 体层摄影术 X线计算机 T分期 

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