螺旋CT三期增强扫描对胃癌TNM分期的研究

目的　评价螺旋CT三期增强扫描对胃癌TNM分期的诊断价值。方法　胃癌 10 1例进行低张水充盈螺旋CT三期增强扫描。结果　 (1)螺旋CT三期增强扫描对胃癌T -分期、N -分期和TNM分期的准确性分别为 81.8%、72 .9%和 80 .2 %。 (2 )动脉期—门脉期胃壁呈多层结构有利于判断胃癌浸润胃壁的深度 (Ρ <0 .0 5 )。 (3 )平衡期肿瘤强化完全有助于判断有无邻近器官受侵。(4 )以淋巴结直径 >5mm为转移标准 ,螺旋CT诊断转移淋巴结的敏感性明显高于以 10mm为转移标准 (Ρ <0 .0 5 )。结论　螺旋CT三期增强扫描能提高胃癌TNM分期的准确性。     

低张服水螺旋CT扫描对胃癌的TNM分期诊断价值

目的 探讨胃癌螺旋CT的TNM分期诊断价值。资料与方法 50例经胃镜证实的胃癌患者进行低张服水螺旋CT扫描。根据胃癌的部位，大小，范围，浸润程度，周围淋巴结及脏器转移情况进行TNM分期，并与术后病理分期对照。结果 低张服水螺旋CT对胃癌TNM分期准确性为76%，其中T分期准确性为78%，N分期准确性为62%，M分期准确性为96%。结论 低张服水螺旋CT检查的TNM分期对评估胃癌的手术方案及临床治疗有较大的价值。     

胃癌16层螺旋CT术前分期与术后病理对比研究

目的:通过研究16层螺旋CT对胃癌述前TNM分期的诊断与手术病理比较,探索其在确定胃癌术前TNM分期中的应用价值。材料和方法:研究对象为72例不同年龄、临床症状及辅助检查疑诊胃癌患者,行常规16层CT平扫加增强三期薄层扫描,扫描后数据经过图形工作站进行二维、三维容积重建处理,多方位显示胃癌病变的部位、范围、大小、侵犯胃壁程度及侵犯周围组织器官的范围,周围各组淋巴结大小及范围,按照国际统一的TMN分期法进行TNM的CT术前分期,并与手术后病理TNM分期对照。结果:16层CT检查结果与手术后病理对照,T分期的准确性94.4%,能够显示黏膜和黏膜下层、肌层、浆膜层侵犯程度;N分期:N0准确性100%、N1准确性90.5%、N2准确性100%。CT多期增强可区别血管与淋巴结,可显示5mm直径的淋巴结影,特别是动脉期及门静脉期扫描特异性较高,有显著差异,淋巴结检出水平明显提高,但直径小于10mm淋巴结敏感性减低;M分期准确性达100%,清晰显示肺转移、肝转移、腹膜后及肠系膜淋巴结转移程度及大小。16层CT对胃癌诊断的敏感性95%,特异性80%,准确性92%,阳性预测值98%。结论:16层CT常规平扫加三期增强扫描合并图像后处理分析,可提高胃癌TNM分期的准确性,是胃癌术前准确分期的可靠方法,对合理制定手术前计划有较高价值。     

64排螺旋CT对两种胃癌淋巴结分期的评估

目的评估64排螺旋CT在两种胃癌淋巴结分期中的价值。资料与方法搜集术前作64排螺旋CT检查且经住院手术证实的资料齐全的56例连续性胃癌病例。设定胃周和胃外淋巴结短轴径≥5mm为肿大淋巴结,由两位高年资医师独立对CT图像进行评估,对淋巴结进行计数,并分别按国际抗癌联盟（UICC）分期和日本胃癌规约（GRGCS）分期方法进行分期。评价在不同分期条件下,64排螺旋CT术前对胃癌肿大淋巴结的诊断准确性的差异。结果56例胃癌,手术共清除淋巴结322枚,短轴径≥5mm的淋巴结共计256枚,其中转移为阳性的淋巴结210枚;64排螺旋CT扫描对全部短轴径≥5mm的淋巴结的显示率为94%（240/256）,检测出的阳性淋巴结百分率为95%（200/210）。对于胃壁旁组和血管旁组的肿大淋巴结,CT显示率和准确率较高。N分期的总体准确性,采用GRGCS方法为80%,UICC方法为77%。其中过高分期在GRGCS方法中的发生率为14%（8/56）,在UICC方法中的发生率为9%（5/56）;过低分期在GRGCS方法中的发生率为6%（3/56）,在UICC方法中的发生率为14%（8/56）。两种N分期方法之间差异无统计学意义（P〉0.05）。结论64排螺旋CT能够较为全面和准确地观察胃癌淋巴结的位置、形态和大小,对于N分期的总体准确性较高,采用GRGCS和UICC分期并无差异。     

螺旋CT扫描对胃癌淋巴结转移的术前评估

目的:评估螺旋CT扫描对显示胃癌淋巴结转移的应用价值.材料和方法:76例经上消化道造影或胃镜诊断的胃癌患者,术前行水充盈法螺旋CT三期扫描;CT所见与手术病理结果对照.结果:螺旋CT扫描对胃癌淋巴结转移显示的敏感性为70%,特异性达79.2%;淋巴结的大小、形态及强化特征有助于阳性淋巴结的诊断.结论:螺旋CT扫描术前评估胃癌淋巴结转移有较大的临床应用价值.     

胃癌螺旋CT与病理、nm23-H1蛋白表达的相关性研究

目的 探讨胃癌螺旋CT征象与手术病理及nm23-H1蛋白表达间的关系.资料与方法 对65例胃癌行低张力水充盈螺旋CT三期增强扫描,所有病例均行手术切除,术后标本采用免疫组织化学SP法检测肿瘤组织中nm23-H1蛋白表达.将螺旋CT诊断结果 与病理结果 、nm23-H1蛋白表达进行对照.结果 65例胃癌TNM分期CT的准确性为80.0%(52/65),nm23-H1蛋白阳性表达率为50.8%(33/65).CT像上的病灶大小、浆膜侵犯、淋巴结转移、TNM分期与病理结果 一致性良好,与nm23-H1蛋白阳性表达率均密切相关(P＜0.05).结论 螺旋CT可较准确地反映胃癌增殖、浸润转移的病理学及生物学特性.     

胃癌螺旋CT表现与组织分化的关系

目的研究胃癌的螺旋CT征象与组织分化之间的关系。方法55例进展期胃癌病人术前行低张力水充盈螺旋CT三期增强扫描,并将螺旋CT结果与术后病理及组织分化结果进行对照。结果(1)螺旋CT上病灶大小、强化特点与胃癌组织分化密切相关(P<0.05);(2)邻近脏器侵犯者均为低分化癌(P<0.05);(3)高/中分化癌61.1%无淋巴结转移,仅16.7%N2转移;低分化癌86.5%发生淋巴结转移,其中N2转移占71.9%(P<0.05);(4)高/中分化癌66.7%为Ⅰ、Ⅱ期,低分化癌89.2%为Ⅲ、Ⅳ期(P<0.05)。结论螺旋CT上病灶的浸润转移与胃癌分化程度密切相关。     

64排螺旋CT对胃印戒细胞癌淋巴结转移的诊断价值

目的：评价64排螺旋CT对胃印戒细胞癌淋巴结转移的诊断价值。方法：回顾性分析总结40例胃印戒细胞癌患者的CT平扫及三期动态增强扫描资料,并与手术病理结果对照。结果：本组病例术后淋巴结转移情况为N0期16例,N2期6例,N3期为11例,CT以淋巴结长径〉6mm为阳性标准,发现NO期16例、N1期7例、N2期5例及N3期4例,其中CT各N分期特异性在76．5％-94．7％之间,但是对N2及N3分期的敏感性欠佳（分别为28．6％和33．3％）。转移淋巴结特点为静脉期和延迟期强化明显,虽高于动脉期强化,但是之间无统计学意义上的差异（P〉0．05）。结论：64排螺旋CT对胃印戒细胞癌转移淋巴结的诊断及N分期有帮助,其诊断特异性较高,但是准确性和敏感性均有待提高。     

胃癌浸润转移:螺旋CT与病理、COX-2蛋白及mRNA表达的相关性研究

目的 探讨胃癌螺旋CT浸润转移与病理及环氧合酶（COX）-2蛋白表达间的关系。资料与方法 对57例胃癌行低张力水充盈螺旋CT三期增强扫描，所有病例均行手术切除，术后标本采用免疫组织化学SP法、原位杂交实验检测肿瘤组织中COX-2蛋白、mRNA表达。将螺旋CT结果与病理结果、COX-2表达进行对照。结果 57例胃癌螺旋CT浸润深度的准确性为82．5％（47／57），淋巴结转移的准确性为78．9％（45／57），4例胃癌发生远处转移螺旋CT均正确诊断，TNM分期的准确性为80．7％（46／57）。COX-2蛋白及mRNA阳性表达率分别为61．4％（35／57）和73．7％（42／57）。CT对胃癌浸润深度、淋巴结转移、TNM分期与病理一致性良好，与COX-2蛋白及mRNA表达率均密切相关（P〈0．05）。结论 螺旋CT可较准确地反映胃癌浸润转移的病理学及生物学特性，从而可指导手术、化学预防和治疗以及评估预后。     

多层螺旋CT胃癌术前TNM分期

目的 评价多层螺旋CT（MSCT）三期动态增强扫描在胃癌术前TNM分期中的作用，资料与方法 32例胃癌患者均在术前6天内行MSCT扫描，检查前20min饮水1000-1200ml，扫描前10min肌注盐酸山莨菪碱20mg。平扫后行三期动态增强扫描，动脉期开始于注射对比剂后30s,60s后为实质期，2min后为平衡期。32例中16例在同期行腔内超声检查，术前CT检查结果由2名资深放射科医师双盲法进行评定TNM分期，评定时根据需要行MPR重建；腔内超声检查由1位内科和1位外科医师分别完成；MSCT及超声分期结果均与手术后病理结果进行比较。结果 对于T分期，MSCT分期T1-T2者敏感性为75%，准确性为68%，T3-T4者敏感性为98%，准确性为88%；特异性淋巴结N分期N1检出敏感性为60%，准确性为50%，N2-N3敏感性为82%，准确性为78%；远处转移本研究中出现较少，敏感性为75%，准确性为75%；综合评价TNM分期提示准确性为75%，腔内超声检查T分期敏感性为95%，准确性为90%；N分期敏感性为30%，准确性为21%；远处转移几乎无法显示，综合TNM分期准确性仅50%。结论 三期动态增强MSCT薄层扫描可在很大程度上提高微小病变的检出率，可较准确地显示正常胃壁结构及胃癌侵犯胃壁的深度，同时可反映淋巴结转移情况及远处脏器的转移和播散，作出准确的TNM分期。MSCT和超声内镜检查两者相结合可有效地为临床手术方案的选择提供指导。     

胃引流区淋巴结短径值与胃癌转移相关性探讨

目的:探讨胃引流区淋巴结短径值大小与胃癌转移的相关性。方法:回顾性分析经手术病理证实并行切除及淋巴结清扫术的38例胃癌的MSCT资料,测量胃周淋巴结短径径值,并与术后病理进行对照研究。结果:38例中,经MSCT于23组胃引流区检出淋巴结共217个,其中阳性淋巴结105个(阳性率48.4%),阴性淋巴结112个;阳性组淋巴结的短径均数为(9.7±6.2)mm,阴性组淋巴结短径均数为(6.0±2.1)mm,两均数间差异有统计学意义(P<0.01)。阳性淋巴结按短径径值大小分为4组,短径1～5mm组阳性率为20.8%(5/24),6～9mm组阳性率为42.5%(54/127),10～15mm组阳性率为61.2%(30/49),15mm以上组阳性率为94.1%(16/17),后3组间差异有统计学意义(P<0.05)。以短径值>5mm为评估阈值,敏感性为95.2%(100/105),特异性为16.1%(18/112);以短径值>10mm为评估阈值,敏感性为43.8%(46/105),特异性为81.2%(91/112)。结论:随着胃引流区淋巴结短径的增大,发生淋巴结转移的可能性增加,但以某一径值作为评估转移阈值,无法同时保证诊断敏感性与特异性,故MSCT评估胃癌淋巴转移不能单纯依靠径值。     

MSCT增强扫描在胃癌术前TNM分期中的临床价值

目的探讨MSCT增强扫描在进展期胃癌的诊断与分期方面的价值。方法对45临床诊断为胃癌的患者进行术前MSCT动态增强扫描,根据结果作出分期诊断,并与手术及病理TNM分期相对照。结果CT表现为胃壁多层结构破坏,淋巴结及邻近脏器的转移。MSCT的T、N、M分期准确率分别为77．8％、71．2％和68．6％。结论MSCT增强扫描术前评估进展期胃癌TNM分期准确性高,对胃癌患者术前评估有较高的临床参考价值。     

MSCT三期增强扫描和后处理技术对胃癌术前分期的评价

目的:探讨多层螺旋CT(MSCT)对胃癌的影像学诊断及其对术前分期的价值。方法:对49例胃癌患者行16层螺旋CT三期增强扫描后,用多平面重建(MPR)和CT仿真内镜(CTVE)等后处理技术对胃癌CT图像进行术前分期评价,并与术后病理分期对照,以术后病理分期为金标准。结果:MSCT T分期:T1期诊断准确率75.00%(6/8),T2、T3、T4期准确率分别为70.59%(12/17)、68.42%(13/19)、80.00%(4/5);N分期:N0期68.75%(11/16),N1期准确率为59.10%(13/22),N2期63.64%(7/11)。M分期中除1例左锁骨上淋巴结转移未行该部位的CT扫描不计入统计之列外,其余48例M分期的准确率为M0为90.91%(40/44),M1为50.00%(2/4)。结论:16层螺旋CT三期增强扫描结合多平面重建和CT仿真内镜等后处理技术对胃癌分期的准确率较高,值得临床推广。     

Evaluation of the "N" factor in nonsmall cell lung cancer. Correlation between computerized tomography and pathologic anatomy

PURPOSE: To evaluate the role of CT in identifying other morphological signs of metastatic lymph node involvement from non small cell bronchogenic carcinoma. This is done to improve N staging, a critical step in this disease. In fact, since diameter is the only criterion used to distinguish normal form abnormal lymph nodes, medistinal CT only has 80% diagnostic accuracy. MATERIAL AND METHODS: 137 patients with known or suspected lung cancer were examined with Helical CT during early and late arterial phases (2 min delay, 3 mm thickness, 5 mm interslice gap) to depict node characteristics. Mediastinal lymph nodes, located according to the American Thoracic Society mapping, were considered normal when they were not visible or, if visible, less than 1 cm in diameter and of homogeneous density; lymph nodes over 1 cm in diameter and homogeneous density were considered reactive. A lymph node was considered metastatic when, independent of size, the following signs were found: central hypodensity; hyperdense thin/thick rim, with nodules within; hyperdense strands or diffuse hyperdensity in perinodal adipose tissue. The tumor site was also considered. RESULTS: Seventy patients were excluded because they were inoperable. Sixty-five of the remaining 67 patients were operated on, 1 underwent mediastinoscopy and another one mediastinoscopy followed by surgery. Based on the above CT signs, 46 patients were staged as N0, 61 as N1 and 15 as N2. In 44/46 N0 patients there was agreement between anatomical and pathologic findings; 3 of the 44 patients had lymph nodes over 1 cm in diameter and with homogeneous density. Micrometastases to mediastinal lymph nodes (N2) were found at histology in 2/46 patients (CT false negatives). In the 6 N1 and the 15 N2 patients there was complete agreement between anatomical and pathologic findings; in particular, 9 N2 patients had lymph nodes less than 1 cm in diameter with signs of metastasis and 4 had lymph nodes over 1 cm in diameter with signs of metastasis and 2 had lymph nodes either over or less than 1 cm. In all N2 patients the tumor histotype and the mediastinal location were also considered relative to the lesion site. DISCUSSION: A closer correlation was found with node morphology and density than with size. Indeed, CT sensitivity, specificity and diagnostic accuracy were 97, 100 and 97%, respectively, for the former versus 52, 93 and 77% for the latter. Adenocarcinoma was the predominant histotype (70.5%) in N2 patients. Metastases to node region 4 were predominant in right upper lobe carcinomas while node region 5 was predominant in left upper lobe lesions. CONCLUSIONS: Other criteria can be associated with size to improve CT diagnostic accuracy in N staging. Technique optimization plays a major role particularly in the late, thin slice, examination phase.     

MSCT对胃癌转移淋巴结的诊断价值

目的 探讨MSCT对胃癌术前N分期及诊断各组转移淋巴结的准确性.方法 回顾性分析经手术病理证实的91例胃癌患者的病理和CT影像资料,术前均行统一方式低张口服水三期动态增强扫描,采用拟定的联合判断标准,对术前CT影像进行淋巴结N分期及分组,与术后病理对照,分期、分组的准确性采用Kappa一致性检验.结果 MSCT对胃癌N分期总的准确率为86.3%,N0、N1、N2、N3分期准确率为83.5%、89.0%、83.5%、89.0%;敏感性为86.5%、83.3%、50.0%、47.4%;特异性为79.5%、89.4%、89.6%、100.0%.N0与N2、N0与N3敏感性之间差异有统计学意义(P≤0.007).MSCT判断各组检出淋巴结准确率较高的为贲门左侧(No.2)、脾门旁(No.10)、胰头后(No.13)淋巴结,为98.9%;敏感性较高的为No.2、腹腔干旁(No.9)、No.10、No.13组淋巴结,为100%;特异性较高的为No.2、No.10、No.13组淋巴结,为98.9%.结论 MSCT对胃癌术前N分期及各组转移淋巴结的诊断具有较高的准确性,对胃癌术前评估、术中淋巴结清扫具有重要的指导意义.     

螺旋CT增强扫描对食管癌淋巴结转移的诊断价值

目的探讨多层螺旋CT(MSCT)强化扫描评价食管癌淋巴结转移的价值。方法35例食管癌患者行MSCT增强扫描(安射力(320mg/100ml)90ml,注射速度2.5ml/s,延迟55s扫描),扫描范围从舌骨水平至肝下缘,将原始数据重建为层厚1.25mm,层间隔1mm,应用多平面重建(MPR)进行图像后处理。CT扫描以气管食管沟淋巴结短径大于5mm、其余区域淋巴结及腹腔淋巴结短径大于10mm为转移标准统计。淋巴结分组按照Korst提出的食管癌淋巴结简化分组标准进行分组。所有患者均接受手术治疗,切除组织均经病理证实。以病理结果为标准,分析MSCT在诊断食管癌淋巴结转移方面的灵敏度、特异度、准确率。结果35例食管癌患者中鳞癌33例,腺癌1例,鳞腺癌1例,手术共清除淋巴结318枚,病理证实66枚有转移。MSCT共诊断淋巴结转移74枚,正确诊断56枚转移淋巴结,其灵敏度、特异度、准确率分别为84.8%、92.9%、91.2%。结论MSCT强化扫描发现食管癌淋巴结转移有较高的准确性和特异性,可为临床术前确定治疗方案提供重要的帮助。     

MSCT结合胃镜对胃癌术前分期与术后病理对照研究

目的通过多层螺旋CT（MSCT）结合胃镜对胃癌进行术前TNM分期，并与术后病理TNM分期对比，探讨MSCT结合胃镜在指导胃癌治疗中的价值。方法对200例胃癌患者术前行MSCT检查，多角度多平面观察病变的位置、范围、大小、胃壁浸润程度和胃周侵犯、邻近淋巴结和远处脏器转移等情况，结合胃镜检查，进行术前TNM分期，并与术后病理TNM分期进行对比分析。结果MSCT结合胃镜做出的术前TNM分期与术后病理TNM分期对比，符合率为95％，差异无统计学意义（P〉O．05）。结论MSCT与胃镜结合，能在治疗前明确胃癌的分期，对临床指导患者治疗手段、手术方式的选择有重要意义，并对患者的预后做出有效的评估。     

Staging of gastric cancer: correlation of lymph node size and metastatic infiltration.

OBJECTIVE: The assessment of lymphatic metastases is an important factor in the staging of gastric cancer. Lymph node size has been used as one criterion for possible nodal metastasis. Although enlarged regional lymph nodes are generally interpreted as metastases, few data are available that correlate lymph node size with metastatic infiltration. MATERIALS AND METHODS: In a prospective morphometric study, the regional lymph nodes from 31 gastrectomy specimens of consecutive patients with primary gastric adenocarcinoma were analyzed. The lymph nodes were counted, the largest diameter of each node was measured, and each node was analyzed for metastatic involvement by histologic examination. The frequency of metastatic involvement was calculated and correlated to lymph node size. RESULTS: A total of 1253 lymph nodes were present in the 31 specimens examined for this study. A mean number of 40 lymph nodes (range, 20-53) were found in each specimen. Of these 1253 nodes, 922 (74%) were tumor-free and 331 (26%) contained metastases. The mean diameter of the lymph nodes free of metastases was 4.1 mm, whereas that of nodes infiltrated by metastases was 6.0 mm (p < .0001). Of the tumor-free lymph nodes, 735 (80%) were less than 5 mm in diameter, whereas 182 (55%) nodes containing metastases were less than 5 mm in diameter. Of the 10 patients without lymph node metastases, seven had at least one node that was 10 mm or greater in diameter; similarly, 15 (71%) of the 21 patients with node metastases had at least one node that was 10 mm or greater in diameter. CONCLUSION: Lymph node size is not a reliable indicator for lymph node metastasis in patients with gastric cancer.