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| 早期胃癌影像学诊断及价值 | |
| 引用本文： | 李佳铮,唐 磊. 早期胃癌影像学诊断及价值[J]. 中国实用外科杂志, 2019, 39(5): 437-442. DOI: 10.19538/j.cjps.issn1005-2208.2019.05.07 |
| 作者姓名： | 李佳铮 唐 磊 |
| 作者单位： | 北京大学肿瘤医院医学影像科，北京市肿瘤防治研究所，恶性肿瘤发病机制及转化研究教育部重点实验室，北京 100142 |
| 基金项目： | 北京市自然科学基金资助项目(No.Z180001);首都临床特色应用研究与成果推广(No.Z161100000516060) |
| 摘 要： | 影像学是早期胃癌(EGC)诊断和评估的主要手段之一,包括X线气钡双对比造影、CT、MRI及PET。X线气钡双对比造影是EGC诊断的经典手段,应用高浓度钡剂,联合双对比、黏膜法及薄层法流动涂抹,可动态观察黏膜面破坏的立体形态。腹部增强CT是EGC分期评价的常规手段之一,推荐使用低张气充盈,强调动脉晚期(40s)增强和多平面重组技术的规范应用。CT显示胃壁内层高强化肿瘤与外层稍高强化肌层间存在连续完整的低强化条带,或黏膜侧高强化肿瘤不超过胃壁总厚度的50%,判断为EGC。后一征象对发生于消化性溃疡基础上的EGC分期诊断意义更大。双能CT有潜力提高EGC的检出和分期准确率。磁共振扩散加权成像(DWI)及动态对比增强(DCE)成像可突出EGC的显示,提高检出。PET对EGC的检出能力有限,但可辅助预测EGC内镜下黏膜切除术(ESD)的根治性及监测术后复发。EGC术后尤其是ESD术后应定期随访,可结合相关风险因素制定随访方案。影像组学具备辅助判断EGC淋巴结转移的潜力。 |
| 关 键 词： | 影像学 早期胃癌 |
Imaging diagnosis and value of early gastric cancer |
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| Jia-zheng,TANG Lei. Imaging diagnosis and value of early gastric cancer[J]. Chinese Journal of Practical Surgery, 2019, 39(5): 437-442. DOI: 10.19538/j.cjps.issn1005-2208.2019.05.07 | |
| Authors: | Jia-zheng TANG Lei |
| Affiliation: | (Department of Radiology,Peking University Cancer Hospital & Institute,Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education),Beijing 100142,China) |
| Abstract: | Imaging diagnosis and value of early gastric cancer LI Jia-zheng,TANG Lei. Department of Radiology，Peking University Cancer Hospital ＆ Institute；Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）， Beijing 100142，China Corresponding author : TANG Lei,E-mail:tangl@bjcancer.org Abstract Radiology is one of the common modalities in the diagnosis and evaluation of early gastric cancer (EGC), which include X-ray double contrast radiography, CT, MRI and PET. X-ray double contrast radiography is a classical method on the diagnosis of EGC. High concentration of barium, with the combination of double contrast, mucosal and thin-layer flow-coating methods, can dynamically observe the three-dimensional morphology of mucosal surface damage. Abdominal enhanced CT is one of the conventional methods for the staging of EGC. Hypotonic air-filling is recommended, and the standardized application of late arterial phase (40 seconds) enhancement and multiplanar reconstruction (MPR) techniques is emphasized. The demonstration of the continuous and complete low-intensity bands between the inner high enhanced cancer layer and outer intermediate enhanced muscularis propria layer of gastric wall, or the thickness of the inner high enhanced cancer layer less than 50% of the total thickness of gastric wall, which were the CT signs of EGC. The latter sign is of greater importance in the staging diagnosis of EGC originated from peptic ulcers. Dual-energy CT has the potential to improve the detection and staging accuracy of EGC. DW-MRI and DCE-MRI imaging can highlight the display of EGC and improve the detection. PET is limited in the detecting ability of EGC, but it can assist in predicting the curative treatment of endoscopic mucosal resection (ESD) of EGC and monitoring the recurrence after ESD. Periodic follow-up should be conducted after the operation of EGC, especially ESD procedures. The follow-up plan can be formulated according to the relevant risk factors. Radiomics has the potential in the diagnosis of lymph node metastasis in EGC. |
| Keywords: | radiology early gastric cancer |
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