超声在老年人空腹时诊断胃癌的应用价值

目的 探讨空腹条件下超声在老年人胃癌诊断与预后中的应用价值.方法 回顾性分析41例超声诊断为胃癌的老年患者的临床资料,将其结果与手术病理对照分析.结果 超声诊断与病理符合39例(95.12％),超声定位诊断与病理符合33例(84.6％),平均符合率为77.50％;进展期胃癌(T2～T3期)与晚期胃癌(T4期)的胃壁厚度差异有显著性(P＜0.05)；血流分级与病理分期及分化程度的关系,其差异有显著性意义(P＜0.05)结论 空腹条件下超声检查可作为老年人胃癌筛查的一种首选方法,可为其诊断及预后评估提供重要信息.     

螺旋CT动态双期增强扫描对胃癌的诊断及分期的价值

目的：分析胃癌螺旋CT动态双期增强扫描的影像表现,进一步评估螺旋CT对胃癌的检出及分期,方法：对42例术前胃镜证实为胃癌的患者进行双期动态螺旋CT扫描。分析CT图像上肿瘤的胃壁侵犯情况及淋巴结检出情况,并与手术,病理进行对照。结果：CT扫描对早期胃癌的检出率为50％,进展期胃癌的检出率为100％,对T1,T2,T3,T4期的准确性分别为50％,83．3％,60％,33．3％,胃癌CT扫描显示胃壁局限性或广泛性增厚,动脉期不均匀强化,静脉期均匀强化。结论：胃壁增厚及动脉期不均匀强化诊断胃癌有意义。虽然螺旋CT对淋巴结的检出率较低,但此方法对临床的手术或非手术治疗还是有重要的指导意义。因此,我们建议胃癌患者术前行螺旋CT动态双期增强扫描。     

多层螺旋CT判断胃癌胃壁浸润深度的价值

目的评价多层螺旋CT(MSCT)术前判断胃癌胃壁浸润深度的效果。方法58例经胃镜证实的胃癌患者(T1至T4)在术前接受MSCT扫描。每个病例都根据CT图像进行胃壁浸润深度的判断,并将诊断结果与术后病理结果进行比较。结果CT的胃壁浸润深度诊断准确率为66%(33/50例),其中T4判断准确率较高,为82%(19/23例);T2、T3的判断准确率相对较低,而T1无法单独依靠CT图像进行诊断。结论MSCT对判断进展期胃癌胃壁浸润深度很有价值,但对早期胃癌的诊断仍必须综合其他的检查手段。     

空腹超声对进展期胃癌的临床价值

目的总结进展期胃癌的空腹超声声像图表现,探讨其临床价值。方法回顾性分析39例进展期胃癌的空腹超声声像图表现,并与手术病理结果进行对比分析。结果进展期胃癌超声声像图主要表现为胃壁局限性增厚,其中TNM分期T2、T3胃壁厚度比较差异无统计学意义(P>0.05),T2、T3与T4胃壁厚度比较差异有统计学意义(P<0.01);随着癌组织浸润深度增加,血流显示率明显增加(P<0.05);超声诊断淋巴结及邻近器官转移符合率为46.87%。结论空腹超声可以对进展期胃癌浸润程度及转移情况进行全面观察,为临床诊断与评估预后提供重要信息。     

胃癌的超声内镜分期和基质金属蛋白酶-7表达的相关性

目的 研究胃癌的超声内镜分期与基质金属蛋白酶-7表达的相关性.方法 33例早期胃癌和56例进展期胃癌术前行超声内镜检查、早期胃癌部分行EMR术,进展期胃癌行根治或姑息手术,所有病例均经病理证实;用免疫组织化学法检测MMP-7的表达.结果 早期胃癌患者的癌组织MMP-7表达水平明显低于进展期胃的组织水平（P＜0.02）,且与胃癌的组织分型明显相关（P＜0.01）.2例黏膜层癌MMP-7表达强阳性的病例,行部分胃切除根治术,有1例发现淋巴结转移,但未被超声内镜发现.4例黏膜下层癌MMP-7表达强阳性的病例,3例发现有淋巴结转移,超声内镜发现1例.结论 胃癌的超声内镜分期与基质金属蛋白酶-7表达相关,MMP-7高度表达的早期胃癌患者应行根治手术.     

胃腔充盈下谐波超声造影对胃良恶性病变的诊断价值

目的 应用胃腔充盈下谐波超声造影技术观察胃良恶性病变,探讨胃良恶性病变的超声造影(contrast-enhanced ultrasound,CEUS)血流灌注特征及胃腔充盈下谐波超声造影技术在胃部疾病诊断中的应用价值.方法 口服胃充盈声学对比显影剂后二维超声观察胃良恶性病变,再以反向脉冲谐波显像技术对25例胃良恶性病变行实时CEUS检查,对比分析良恶性病变的造影灌注特征.结果 口服胃充盈声学对比显影剂后二维超声胃炎表现为胃壁增厚层次可见,溃疡可见胃壁局部凹陷,胃间质瘤见胃壁局限性肿物凸向胃腔,胃癌呈胃壁不规则增厚层次消失.CEUS实时观察,胃炎性病变增厚胃壁与周围正常胃壁同步增强及退出,小溃疡边界更为清晰,较大溃疡CEUS早期可见溃疡底部及周边增厚胃壁内纵行梳齿状的微血管显示,胃间质瘤清晰显示肿物位于胃壁内,胃癌可见病变胃壁快速整体增强,增强顺序紊乱层次不清.结论 胃腔充盈下谐波超声造影技术能够很好的显示胃壁全层病变的形态范围,并能结合病变区域微血管灌注情况,对病灶的定位、良恶性鉴别及肿瘤浸润深度有更进一步的判断.     

超声扫描对胃癌浸润深度诊断的应用

本文应用体表超声扫描对102例各期胃癌患者进行了探测。癌浸润深度的判定结果与病理组织学对照,符合率为74.5％,略高于术中肉眼判定。作者认为超声扫描所测的胃壁厚度不能作为判定癌肿浸润深度的依据,早期癌与进展期癌的胃壁厚度均数间有极显著差异,P<0.01,而进展期癌中的浸至肌层与浆膜层之间则无显著差异,P>0.05。应用超声检查可补充X线与胃镜在胃癌定量诊断方面之不足。     

螺旋CT三期增强扫描对胃癌T分期的诊断价值

目的　评价螺旋CT三期增强扫描正常胃壁及肿瘤的强化特点 ,及对胃癌T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　 99例胃癌经手术病理证实 ,T分期的准确性为 81.8%。在动脉期～门脉期 ,胃壁呈多层结构的T分期准确性明显高于胃壁呈单层结构。在平衡期 ,肿瘤完全强化 ,纠正了 7例动脉期 门脉期所造成的分期错误。结论　螺旋CT三期增强扫描提高了胃癌T分期的准确性。     

超声检查对胃癌的诊断价值

目的探讨超声对胃癌诊断的价值。方法选择21例超声诊断胃癌经胃镜、手术及病理证实的患者,先经腹扫查胃区及周围组织,然后饮造影剂,逐段扫查贲门、胃底、胃体、胃窦部必要时扫查邻近器官和周围淋巴结,观察胃壁是否平滑、胃壁厚度、层次是否清晰及蠕动情况。结果超声显像诊断超声显像诊断胃窦占位病变l0例,胃体占位病变6例,胃壁增厚原因待查3例,大部份胃内弥漫占位2例,后腹膜淋巴结肿大5例。结论超声检查可以作为胃癌辅助检查手段。     

巨大胃壁异位胰腺误诊为胃癌1例

胃壁异位胰腺较少见，我院见到1例，经上级医院手术后病理证实。图1胃大弯侧示巨大充盈缺损，约6cmXIocm大小，轮廓呈波浪状，其下界胃壁示一小折角。图2胃大弯侧粘膜消失，肿块周围尚有数条完整的胃体部纵行粘膜。患者男，33岁，间断性上腹痛5年，8个月前有胃出血病史。体检：左上阴压痛．可触及不规则肿块。初餐造历检查：自体大奇侧示较大充盈缺损，约6cmXIbm大小，基底广阔，呈波浪状轮廓，胃体胶明显狭窄，大弯侧粘膜消失，病变周围尚有数条纵行胃体粘膜，病变下界胃壁可见类似痛折角样改变，胃壁较硬，蠕动消失，x线诊断胃癌（图1、…     

胃壁厚度在超声筛查胃部病变中的价值

目的探讨口服造影剂胃超声检查在胃部病变筛查中的应用价值。 方法纳入2015年1月至2018年12月于中山大学附属第八医院体检行胃超声检查同时取得胃镜检查结果者3573例。超声观察胃腔、胃壁及胃周结构,并测量胃壁厚度。分析胃超声检查与胃镜诊断结果,绘制胃壁厚度评估胃病变的ROC曲线,并计算ROC曲线下面积、最佳截断值及诊断敏感度和特异度。采用线性加权Kappa检验对胃壁厚度评估胃部病变的结果与胃镜检查结果进行一致性分析。 结果所有纳入对象经术后病理证实胃癌20例。胃超声检查筛查出18例胃癌,均经手术病理证实为胃腺癌。超声检查漏诊2例,误诊2例。胃镜漏诊1例。以手术病理、胃镜活检病理结果及胃镜结合临床随访结果为诊断标准,绘制胃壁厚度评估正常胃壁与病变胃壁的ROC曲线。ROC曲线下面积为0.946（95%CI：0.930~0.962）,最佳截断值为5.5 mm,其诊断敏感度和特异度分别为97.5%和98.3%。绘制胃壁厚度评估肿块胃壁与非肿块胃壁的ROC曲线。ROC曲线下面积为0.829（95% CI：0.758~0.900）,最佳截断值为9.5 mm,其诊断敏感度和特异度分别为79.7%和75.9%。基于ROC曲线阈值分析结果,以胃壁厚度为依据诊断不同病变,胃壁厚度＜6 mm判定为正常或非糜烂性胃炎,6 mm≤胃壁厚度≤9 mm判定为糜烂性胃炎,胃壁厚度＞9 mm判定为肿块。对胃壁厚度评估结果与胃镜检查结果进行一致性分析,Kappa值为0.792（P＜0.001）。 结论胃壁厚度评估胃部病变与胃镜诊断结果一致性较好,胃超声检查作为一种简便、快捷的胃疾病筛查手段,对于胃癌的筛查及其他胃部疾病的初筛及随诊具有重要意义。     

86例胃癌的CT临床诊断

目的:探讨CT在胃癌的临床诊断作用。材料和方法:观测了20例健康胃壁在空腹和充盈后的变化;分析86例以手术或病理证实的胃癌的CT表现;就其中31例我院有完整手术记录者,进行CT与手术病理对照研究。结果:(1)空腹状态下正常胃壁厚度普遍大于1.0cm;胃底、体和窦部厚度依次减低。(2)86例胃癌中,除6例(占7％)CT未显示明确异常外,余80例(93％)CT分别表现为为肿块型(18例,占20.9％)和局限或弥漫胃壁增厚型(62例,占72.1％);(3)31例手术与CT对照,发现CT对局部淋巴结转移的诊断准确率为73.3％,特异性为69.0％,敏感性为68.8％。结论:CT是胃癌术前全面评价病灶部位、范围、邻近脏器转移、淋巴结异常的重要补充手段。     

Ultrasonography of benign gastric ulcers. Characteristic features and sequential follow-ups

Ultrasonography was performed for 15 patients with gastric ulcers, after tap water ingestion using 5-MHz and/or 7.5-MHz transducers. Sonographic signs of gastric ulcer were classified as gastric wall edema associated with ulcer crater (six cases) and gastric wall edema only (nine cases). The latter nine included two cases of perforation of gastric ulcers that were depicted as gastric wall edema associated with fluid collection. Ultrasonography proved useful for detecting benign ulcerations and can be used to supplement follow-up examinations, but it cannot replace endoscopy and contrast radiography.     

Endoscopic sonography in the diagnosis and treatment of a gastric wall abscess: a case report and review of the literature

We report a case of a gastric wall abscess in a 50-year-old man who presented with epigastralgia and fever. Gastroscopy revealed a subepithelial lesion on the posterior wall of the gastric body into the antrum. A follow-up abdominal CT scan showed cystic lesions around the stomach. Endoscopic sonography helped to diagnose a gastric wall abscess. The gastric wall abscess was treated endoscopically with a needle knife incision for internal drainage. The patient was treated with antibiotics for 1 week and was discharged without complication. A follow-up endoscopy with endoscopic sonography 1 month later revealed complete resolution of the lesion.     

The gastric air-fluid sign: Aid in CT assessment of gastric wall thickening

The differentiation of apparent gastric wall thickening due to incomplete gastric distention from true pathologic wall thickening can be difficult on computed tomographic (CT) scanning. We have observed a transition in gastric wall thickening that is often present at or slightly above the gastric air-fluid or air-contrast level. The apparently thickened gastric wall in the dependent portion of the stomach undergoes an abrupt change to normal thickness at or above the air-fluid level.Review of CT scans in 259 patients without known or suspected gastric pathologic conditions revealed this finding, termed the gastric air-fluid sign, in 57 patients (22%). While not considered diagnostic, the presence of this sign may allow for a greater degree of confidence in the CT assessment of gastric wall thickening in an appropriate clinical setting.     

Sonography of polypoid gastric lesions by the fluid-filled stomach method

The fluid-filled stomach allows visualization of the gastric wall on real-time ultrasonic examination. In four cases with small focal gastric wall lesions (two cases with hyperplastic polyps, one with pseudopolypoid lesions, and one with polypoid infiltration of the gastric mucosa by maligant lymphoma), typical ultrasonic pictures were demonstrated. The polypoid lesions were located on the anterior and posterior gastric walls and at the gastric fundus, respectively. All who use the gastric sonic window for imaging the pancreas or the left upper abdomen should be aware that focal gastric lesions are also observable.     

Use of Endoscopic Ultrasound to Evaluate Large Gastric Folds: Features Predictive of Malignancy

The aim of this study was to investigate with endoscopic ultrasound (EUS) the features of the gastric wall that can be used to predict malignant disease in patients with large gastric folds. We retrospectively reviewed the EUS findings of 65 patients (26 with benign and 39 with malignant disease) with large gastric folds on endoscopy and EUS and analyzed the predictors of malignant disease (e.g., gastric wall thickness, preservation of five-layered structure, thickened layers). Gastric wall thickness (≥9.8 mm), thickened deep layer, thickened muscularis propria and non-preserved wall layer structures were significantly more prevalent in patients with malignant disease on EUS. Among them, gastric wall thickness (≥9.8 mm) (odds ratio = 6.72, 95% confidence interval = 1.23–36.73, p = 0.028) and thickened muscularis propria (odds ratio = 37.14, 95% confidence interval = 7.02–196.49, p < 0.001) were significantly associated with malignant disease. Our data indicate that EUS is a useful tool for assessing large gastric folds and that gastric wall thickness (≥9.8 mm) and thickened muscularis propria are significant features predictive of malignant disease on EUS.     

Ultrasonic examination of the wall of the fluid-filled stomach

The ultrasonographic examination of the fluid-filled stomach in five standardized positions permits the transabdominal visualization of the gastric wall in all sections of the organ. In a prospective study, 107 patients were examined--68 with a pathological change in the wall of the stomach and 39 with no gastric disease. In 56 patients (82.4%) the lesion was correctly identified. In addition to wall-infiltrating processes and stenoses, circumscribed space-occupying lesions were also detected; for example, localized carcinomas, leiomyosarcomas, lymphomas, leiomyomas, polyps, giant folds, and impressions of the gastric wall. Thirty-seven patients (94.9%) with no gastric disease were considered normal at the ultrasonographic examination. The procedure suggests itself not only as a supplement to endoscopy and diagnostic X-rays, but also as a diagnostic alternative in selected patients who cannot be stressed by these methods. The exclusion of gastric disease by this technique is not possible.     

The prevalence and significance of increased gastric wall radiotracer uptake in sestamibi myocardial perfusion SPECT

Background: Limited available data indicate that a specific pattern of increased gastric wall radiotracer uptake is associated with dyspepsia. Our purpose was to evaluate the frequency of this finding and its relation with dyspeptic evidences. Method: 1056 consecutive outpatients referred for myocardial perfusion SPECT were interviewed concerning the dyspeptic symptoms, current gastric medications and previous gastroduodenal interventions. The intensity of gastric wall activity was graded qualitatively as G1 or hyperactive gastric wall (equivalent to the patient’s heart activity) and G2 (less than heart activity). Results: The pattern of gastric wall hyperactivity was identified in 1.9% of patients. Dyspeptic symptoms were present in 80 and 18.6% of G1 and G2 patients, respectively (p<0.001). The dyspeptic symptoms were classified as ulcer-like in 37.5%, dysmotility-like in 43.75% and GERD-like in 18.75% of the dyspeptic G1 patients. Considering the classification of dyspepsia, there was no significant difference between the dyspeptic patients of groups. The history of previous gastroduodenal interventions and current use of gastric medications was significantly higher among G1 patients. Conclusion: The infrequent pattern of gastric wall hyperactivity could be clinically important and can identify a category of patients, who require additional diagnostic gastrointestinal investigation to specify another possible noncardiac origin of complaints.     

限局性胃壁伸展不良征对较小早期胃癌的诊断价值

目的探讨限局性胃壁伸展不良征对较小早期胃癌的诊断价值.方法收集24例资料完整的早期胃癌,对其行X线双对比造影片与胃切除标本对照,分析造影所见及其病理基础.结果 24例全部为病灶小于2cm的表面型早期胃癌,均表现为胃大、小弯轮廓线某一局部的轻微凹陷.凹陷的局部轮廓线可呈现单层或双层外观.凹陷程度与癌浸润深度有关;凹陷式样(单层或双层)与病变宽径有关. 结论良好的双对比造影对仅表现为限局性胃壁伸展不良的较小早期胃癌具有较高的诊断能力.