MSCT动态增强扫描及血清肿瘤标志物水平鉴别进展期胃癌和胃淋巴瘤的价值  

Value of dynamic enhanced MSCT scanning and serum tumor marker levels in differentiating advanced gastric cancer from gastric lymphoma

作　　者：冯浩 叶黛西 吉盛超 FENG Hao;YE Daixi;JI Shengchao(Department of Imaging,The 904 th Hospital of Joint Logistics Support Force,Wuxi 214044,China)

机构地区：[1]联勤保障部队第904医院影像科,江苏无锡214044

出　　处：《中国肿瘤外科杂志》2024年第5期480-485,共6页Chinese Journal of Surgical Oncology

基　　金：江苏省自然科学基金(BK20221272)。

摘　　要：目的探讨多层螺旋CT(MSCT)动态增强扫描及血清肿瘤标志物水平鉴别进展期胃癌和胃淋巴瘤的价值。方法选择2014年3月至2023年3月联勤保障部队第904医院收治的21例胃淋巴瘤(胃淋巴瘤组)及87例进展期胃癌(胃癌组)患者为研究对象。两组患者先行CT平扫,再行MSCT动态增强扫描,并检测血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)水平。观察、记录两组患者胃黏膜状况、胃壁受累范围、胃腔狭窄程度、腹腔和腹膜后淋巴结肿大情况,以及平扫CT值和增强三期扫描的CT值,包括动脉期和门脉期的强化净增值,对比其强化程度、均匀度;对比两组患者的CEA、CA19-9、CA125水平。通过ROC曲线分析CT强化净增值和CT联合肿瘤标志物对胃癌和胃淋巴瘤的诊断效能。结果胃癌组出现黏膜白线征例数显著高于胃淋巴瘤组,胃癌组出现黏膜掀起征、腹腔及腹膜后淋巴结肿大例数显著少于胃淋巴瘤组,胃癌组胃壁侵犯范围<50%、胃腔僵硬及狭窄例数显著高于胃淋巴瘤组,差异有统计学意义(P<0.05)。胃癌组患者动脉期、门脉期、延迟期CT值及动脉期、门脉期强化净增值显著高于胃淋巴瘤组患者,差异有统计学意义(P<0.05)。两组患者平扫CT值比较差异无统计学意义(P>0.05),但在强化程度和强化均匀度上差异有统计学意义(P<0.05)。对比胃癌组与胃淋巴瘤组患者的CEA水平,前者显著高于后者,差异有统计学意义(P<0.05),而CA19-9、CA125水平组间比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,CT动脉期强化净增值、门脉期强化净增值、动脉期与门脉期强化净增值联合及CT联合肿瘤标志物诊断胃癌和胃淋巴瘤的曲线下面积分别为0.829、0.799、0.874、0.938,敏感度分别为0.837、0.816、0.885、0.943。结论MSCT动态增强扫描及血清CEA水平在鉴别进展期胃癌和胃淋巴瘤中具有一定价值。Objective To evaluate the value of dynamic enhanced multislice spiral CT(MSCT)scanning and serum tumor markers in distinguishing advanced gastric cancer from gastric lymphoma.Methods 21 patients with gastric lymphoma and 87 patients with advanced gastric cancer admitted to The 904 th Hospital of Joint Logistics Support Force from March 2014 to March 2023 were selected as the study objects.In the two groups,CT plain scan was performed first,then dynamic enhanced MSCT scan was performed,and the levels of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 125(CA125)were detected.The mucosal condition,extent of gastric wall invasion,degree of gastric cavity stenosis,and enlargement of abdominal and retroperitoneal lymph nodes in patients with gastric lymphoma and gastric cancer were observed and recorded;The CT values of gastric lymphoma and gastric cancer patients on plain scan,as well as the CT values of enhanced three-phase scan,enhanced net increment in arterial and portal phases were recorded;The degree and uniformity of enhancement in patients with gastric lymphoma and gastric cancer were compared;The levels of CEA,CA19-9,and CA125 in patients with gastric lymphoma and gastric cancer were compared.The diagnostic efficacy of CT enhanced net increment and CT combined with tumor markers for gastric cancer and gastric lymphoma was analyzed by ROC curve.Results The number of gastric cancer patients with mucosal white line sign is significantly higher than that of gastric lymphoma patients.The number of gastric cancer patients with mucosal lifting sign,abdominal and retroperitoneal lymph node enlargement is significantly lower than that of gastric lymphoma patients.The range of gastric wall invasion in gastric cancer patients is less than 50%,and the number of gastric cavity stenosis is significantly higher than that of gastric lymphoma patients,with statistical significance(P<0.05).CT value of arterial stage,portal stage,delayed stage and net increment of arterial stage and porta

关 键 词：胃癌 胃淋巴瘤 多层螺旋CT 增强扫描 癌胚抗原 诊断与鉴别诊断 

分 类 号：R735.2[医药卫生—肿瘤]