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。

The Comparative Study between 16-slices Spiral CT and Pathology in Staging of Gastric Cancer

Purpose:To discuss the diagnostic value of 16-slices CT for the preoperative TNM staging of advanced stomach cancer,compared with surgery and pathology.Materials and Methods:16-slices CT using pre-contrast and post-contrast scanning was performed in 72 cases of clinical suspected stomach cancer.Images reconstructed on the graphic workstation were showed the location,range,size and adjacent tissue of tumor invasion,as well as local lymph node status to distinguish early and advanced stomach cancer for TNM staging.Results:Compared with surgery and pathology,T staging accuracy was 88%,and 16-slices CT could show involvement status of mucosa,submucosa,muscle and serosa.N staging was marked difference compared with other staging in the high detecting level and the low sensitivity of lymph node.M staging accuracy was 100 %.The sensitivity,specificity,accuracy and positive rate of 16-slices CT for diagnosing of stomach cancer were 95%,80%,92% and 98%,respectively.Conclusion:16-slices CT using triphase incremental scanning and image post processing improved the accuracy of T and M staging of stomach cancer and was credible means for the preoperative stage of gastric cancer,which was valuable to choose reasonable preoperative planning.The reasonable choice of CT scanning and three-dimensional reconstruction means can effect on showing of tumor clearly.