胃充气状态下上腹部增强CT扫描判断贲门癌的可切除性

目的 探讨胃充气状态下上腹部增强CT扫描对贲门癌可切除性的判断价值。方法 77例贲门癌患者术前行胃充气状态下上腹部增强CT扫描，对贲门癌切除的可能性进行预测，将预测结果与手术结果相对照。结果 预测55例能完成根治性手术切除的病人中，53例行根治性切除，2例行姑息性切除。预测22例不宜手术，结果11例手术探查，10例姑息切除，2例根治性切除。其判断贲门癌不能手术切除的阳性预测值为90．9％，阴性预测值为96．4％。结论 胃充气状态下上腹部增强CT扫描对贲门癌可切除性的估价有重要价值。     

多层螺旋CT多平面重组对胃癌术前T和N分期价值并与病理对照

目的前瞻性研究多层螺旋CT多平面重组(MPR)在胃癌术前T、N分期中的价值。资料与方法经本院医学伦理委员会批准,在与所有受检者签署书面知情同意书后,对连续44例经胃镜活检证实的胃癌患者,采用多层螺旋CT在服产气粉和水(500～1000ml)充分扩张胃后行低张动态增强扫描,其中39例手术的病例入选此次研究。由一名放射诊断医师采用交互方式实时MPR确定能较好地显示病灶和毗邻组织器官结构关系的成像方位进行重组。由两名经验丰富的放射诊断医师分别依据横断位及MPR图像通过协商对肿瘤的显示和T、N分期进行评价,并与病理组织结果对比。采用McNemar检验比较横断图像和MPR图像对原发肿瘤的显示以及T和N分期的准确性有无差别,P<0.05认为有统计学意义。由一名即将参与手术的外科医师评估横断位和MPR图像对传递诊断信息的效率。结果对原发胃癌病灶的检出率,横断图像和MPR图像分别是94.9%(37/39)和97.6%(38/39)。MPR评估胃癌灶对胃壁侵犯深度(T分期)的准确性为87.2%(34/39),较横断图像的61.5%(24/39)高(P=0.002)。MPR对淋巴结转移评价(N分期)的准确性为69.2%(27/3...     

Postpyloric Balloon Occlusion to Increase Technical Success during Pediatric Percutaneous Gastrostomy/Gastrojejunostomy Tube Placement

Gastric distension through insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement; however, poor or incomplete gastric distention can occur, despite the use of glucagon, and lead to rapid egress of air from the stomach into the duodenum. This report describes the adjunctive technique using postpyloric balloon occlusion in 29 patients to maximize gastric insufflation during G/GJ tube placement after failure of conventional methods. Balloon occlusion was successful in salvaging 23 of 29 (79.3%) of G/GJ tube placements without any complications.     

CT of the stomach and duodenum

CT has become an important tool in the diagnosis and management of diseases that affect the stomach and duodenum. By depicting the bowel lumen, wall, and extramural structures, CT can provide unique information that complements standard air contrast radiography and endoscopy. Proper scanning methods and knowledge of normal anatomy are necessary for optimal results. We utilize the gas contrast technique for organ-specific examination in patients with known or suspected gastroduodenal disease. Gastric adenocarcinoma is an important indication for CT evaluation. Unfortunately, early hopes that CT could accurately stage gastric cancer have not been realized. CT is not as accurate as laparotomy in staging early gastric cancer, primarily owing to its inability to detect small peritoneal implants, diagnose metastases in normal-sized lymph perigastric nodes, and predict pancreatic invasion. Nevertheless, CT retains an important role in depicting gross metastatic disease and guiding percutaneous biopsy, particularly in patients who are deemed poor surgical candidates or have undergone prior gastric resection. A variety of conditions other than primary gastric adenocarcinoma produce recognizable abnormalities on CT. Gastric lipoma, leiomyosarcoma, and varices have a distinctive appearance. Others, including gastritis and uncomplicated peptic ulcer, produce nonspecific gastric wall thickening. Endoscopic correlation and biopsy are required for specific diagnosis in these cases. The duodenum, by virtue of its location in the anterior pararenal compartment of the retroperitoneum, may be involved by numerous benign and malignant conditions. In blunt trauma, complicated pancreatitis, and peptic ulcer disease, as well as primary and metastatic malignancy, CT can provide data that may alter patient management.     

Gastric cancer: preoperative local staging with 3D multi-detector row CT--correlation with surgical and histopathologic results

PURPOSE: To prospectively evaluate accuracy of multi-detector row computed tomographic (CT) images for preoperative staging of gastric cancer by using surgical and histopathologic results as reference standards. MATERIALS AND METHODS: This study had institutional review board approval; informed consent was obtained from all patients. Multi-detector row CT included acquisition of virtual gastroscopy images after air distention and contrast material-enhanced dynamic transverse and multiplanar reformation (MPR) images after water distention. Fifty-five consecutive patients with gastric cancer (38 men, 17 women; age range, 37-84 years; mean age, 63 years) underwent preoperative CT. All received 6 g of gas-producing crystals before unenhanced CT scanning for gastric distention and virtual gastroscopy. Patients drank 800-1000 mL of tap water to establish a background for dynamic contrast-enhanced CT scans. Images were obtained in late arterial, portal venous, and delayed phases with start delays of 40, 70, and 150 seconds, respectively. All patients underwent surgery. CT findings were compared with surgical and histopathologic results. Differences in accuracy of transverse and MPR images for T and N staging were assessed with the McNemar exact test. Statistical significance was inferred at P < .05. RESULTS: Detection rates of primary tumors with transverse images, MPRs, and combinations of MPR and virtual gastroscopy images were 91% (50 of 55), 96% (53 of 55), and 98% (54 of 55), respectively. Overall accuracy in assessment of tumor invasion of the gastric wall (T stage) was significantly better with MPR images (89% [49 of 55]) than with transverse images (73% [40 of 55]) (P < .01). Overall accuracy for lymph node (N) staging was 78% (43 of 55) with MPR images and 71% (39 of 55) with transverse images. This difference was not significant (P = .103). CONCLUSION: Multi-detector row CT with combined water and air distention can improve the accuracy of preoperative staging of gastric cancer. MPRs yield significantly better overall accuracy than transverse images for tumor staging but not for lymph node staging.     

Assessment of gastric cancer: value of breathhold technique and two-phase spiral CT

The purpose of this study was to evaluate the capabilities of subsecond spiral CT in detecting and staging of gastric cancer. Our study included 40 patients with endoscopically detected gastric carcinomas. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of scopolamine and drinking of 500 ml water. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase. Gastric tumour extention and lymph node involvement was assessed. Gastric cancer was detected in 39 of 40 cases (sensitivity 97.5 %). Location of the tumour was correctly assessed in all cases. In 31 of the 39 cases (79.4 %) CT staging was accordant with pathological staging. One hundred two (70 %) of 145 nodes infiltrated by tumour tissue were detected and 144 (42.8 %) of 336 nodes free of metastatic involvement were found. The predictive values of positive and negative results for the detection of lymph node metastases were 67.1 and 75 %, respectively. Spiral CT is recommended for staging of gastric cancer. Received: 21 November 1997; Revision received: 9 March 1998; Accepted: 10 March 1998     

Dedicated multidetector CT of the stomach: spectrum of diseases.

Multidetector computed tomography (CT) offers new opportunities in imaging of the gastrointestinal tract. When thin collimation is used, near-isotropic imaging of the stomach is possible, allowing high-quality multiplanar reformation and three-dimensional reconstruction of gastric images. Proper distention of the stomach and optimally timed administration of intravenous contrast material are required to detect and characterize disease. In contrast to gastroscopy and double-contrast studies of the stomach, CT provides information about both the gastric wall and the extragastric extent of disease. Preoperative staging of gastric carcinoma appears to be the main clinical indication for multidetector CT. In addition, multidetector CT allows detection of other gastric malignancies (lymphoma, carcinoid tumors, metastases, gastrointestinal stromal tumors) and benign gastric tumors (neural tumors, polyps). Gastric inflammation (gastritis, ulcers, Ménétrier disease) and miscellaneous gastric conditions (emphysema, gastric outlet obstruction, varices) can also be visualized with multidetector CT. Multidetector CT is a valuable tool for the evaluation of gastric wall disease and serves as an adjunct to endoscopy.     

螺旋CT扫描及仿真内窥镜技术在胃癌中的诊断价值

目的探讨螺旋CT扫描及CT仿真内窥镜成像技术在胃癌中的临床诊断价值。方法对临床28例经病理证实的胃癌患者行螺旋CT扫描,层厚为5mm,螺距为1,将所得的容积数据传至工作站,应用NavigatorSmooth功能行CT仿真内窥镜(CTVE)成像,其结果与胃镜和/或手术病理结果比较。结果28例中,螺旋CT平扫能客观反映出胃壁病变的部位、形态及大小,病灶与周围组织器官的关系及邻近结构受侵情况。其中大网膜、胰腺及肝脏受侵分别为7例、4例及3例,淋巴结转移3例。CTVE成像能很好地显示出正常胃壁内部结构,病灶的立体形态、大小及范围。28例中26例诊断结果与病理结果对照基本相符。准确率高达92.8%。结论CTVE成像与螺旋CT平扫相结合,对胃癌具有较高的临床诊断价值。     

CTA显示胃周动脉及其变异在胃癌术前评价中的应用价值

目的探讨CT血管造影(CT angiography,CTA)显示胃周动脉及其变异在胃癌术前评估中的应用价值。资料与方法对连续67例经胃镜活检证实或高度怀疑胃癌的患者,采用多层螺旋CT在患者服用产气粉和水(500～1000 ml)充分扩张胃后经静脉用压力注射器以3～4 ml/s的流率团注碘对比剂100 ml(碘必乐或碘普罗胺370),采用Bolus-Tracking追踪触发技术行三期增强扫描。在CT工作站采用容积再现(VR)和最大密度投影(MIP)重组CTA以显示胃周血管影像,重点分析变异动脉对手术方案的抉择与实施的影响,并与手术发现比较。结果 67例胃左动脉(LGA)均被显示,胃右动脉(RGA)的显示率为52.24%(35/67)。CTA显示12例胃周动脉变异。其中61例实施手术治疗,CTA获得的血管解剖信息与手术所见取得较好的一致性。结论 CTA能显示胃周主要动脉及其解剖变异,特别是与胃癌原发灶解剖密切相关并对手术实施有影响的血管,附加的CTA可以提高胃癌CT检查的成本效益比。     

Usefulness of the non-distension of the stomach in the evaluation of perigastric invasion in advanced gastric cancer by CT

The purpose of this study was to evaluate by CT the usefulness of the non-distension of the stomach in determining invasion of the gastric cancer into perigastric space and adjacent organs. Forty-eight patients with pathologically proved gastric cancer were studied by conventional CT. Patients were examined using two techniques: (a) non-distension of the stomach in the supine position and 34 patients additionally in prone position; and (b) distension of the stomach with water or air in the supine and/or prone position. CT findings by both techniques were separately analysed preoperatively and compared to surgical findings. Invasion of perigastric fat was better demonstrated by the non-distension technique in 15 of the 36 patients with pathologically proven fat infiltration. Non-distension technique was more accurate than distension in detecting: (a) involvement of gastric ligaments (80 versus 67% for gastrohepatic, 85 versus 73% for gastrocolic and 80% by both techniques for gastrosplenic ligament); (b) perigastric lymphadenopathy (86% by both techniques for lymph nodes sited at the gastrohepatic ligament, 85 versus 75% for gastrocolic and 85 versus 80% for gastrosplenic ligament lymph nodes, respectively); and (c) pancreatic invasion (86 versus 80%). The prone position with non-distended stomach was particularly helpful in excluding pancreatic invasion in five patients with carcinoma of the gastric body. The distension technique was more accurate in demonstrating perigastric extension in gastroesophageal junction tumors in two patients. In conclusion, additional CT of the non-distended stomach with the patient in prone position can provide further evidence about infiltration of the perigastric fat, ligaments, lymph nodes and pancreas, in patients with gastric carcinoma, with the exception of gastroesophageal junction tumors.     

Radiological diagnosis of splenic metastasis and its prevalence at autopsy]

CT and US findings of 7 cases of splenic metastases are described and the prevalence of splenic metastases at autopsy in 641 cases with malignant tumors were evaluated. Metastatic foci in spleen appeared mostly as poorly-defined low density masses on CT. Iodinated contrast material was administered in 2 cases, but no contrast enhancement was observed. US showed both hypoechoic and hyperechoic patterns. These appearances were nonspecific, but were similar to those of metastatic lesions in the liver which were often visible on CT associated with splenic metastases. At autopsy splenic metastases were found in 34 of 641 cases (5.3%). Gastric, colon, lung and ovarian cancers were most common primary tumors. However, the rate of splenic metastasis per tumor was highest in ovarian cancer (50.0%), followed by malignant melanoma (33.3%), colon cancer (16.2%) and gastric cancer (8.2%). Hepatoma which had the biggest number of autopsy cases in this series showed the lowest rate of splenic metastasis (0.8%).     

16层螺旋CT在胃癌诊断中的应用价值

目的探讨16层螺旋CT（MSCT）在胃癌诊断中的应用价值。方法对46例经胃镜组织活检证实的胃癌患者行16层螺旋CT平扫及三期（动脉期、静脉期和平衡期）动态增强扫描,分析其检查结果,并与手术病理结果相比较。结果胃癌的螺旋CT表现主要为胃壁增厚,胃壁多层结构破坏,胃腔内或外软组织肿块,伴有溃疡、胃周浸润、淋巴结转移。增强后病变胃壁异常强化,术前CT正确分期43例（93%）。结论16层螺旋CT三期动态增强扫描对胃癌患者的术前分期诊断有较高价值,对指导胃癌手术及判断预后具有重要意义。     

胃壁厚度与口服对比剂量之间关系的研究

目的：研究胃壁厚度与口服对比剂量之间的关系。材料和方法：通过三组６５ 例服用不同量对比剂者胃壁厚度的测量和研究，胃标本扫描模拟胃气液面征现象。结果：表明增强扫描胃扩张良好时胃壁呈均一性增强，中等度扩张时胃内常见到较多的粘膜皱襞，胃扩张不充分时胃襞明显增厚并可显示多层结构。结论：认为测量胃壁厚度时应使胃处于良好的扩张状态。胃扩张不充分时部分病例显示胃气液面征。     

Benign and malignant lesions of the stomach: evaluation of CT criteria for differentiation

PURPOSE: To determine the sensitivity and specificity of computed tomographic (CT) criteria for differentiating benign from malignant stomach lesions in patients with a thickened gastric wall at CT. MATERIALS AND METHODS: A radiology department file search revealed 36 patients with a thickened gastric wall at CT who underwent double-contrast barium suspension upper gastrointestinal tract examinations within 6 weeks before or after CT. The authors reviewed the CT images without knowledge of the final radiologic, endoscopic, or pathologic findings to determine the degree of gastric wall thickening and the symmetry, distribution, and enhancement of the thickened wall. The sensitivity and specificity of these findings for detection of malignancy were calculated. RESULTS: Two of 36 patients had two gastric abnormalities each. The final diagnoses in the 38 cases were gastritis in 19, hiatal hernia in four, benign ulcer in three, benign (n = 3) or malignant (n = 8) gastric neoplasm in 11, and no gastric abnormality in one case. Mean wall thickness was 1.5 cm (range, 0.7-7.5 cm). The finding of gastric wall thickness of 1 cm or greater had a sensitivity of 100% but a specificity of only 42% for detection of malignant or potentially malignant stomach lesions. The finding of focal, eccentric, or enhancing wall thickening had a sensitivity of 93%, 71%, or 43%, respectively, and a specificity of 8%, 75%, or 88%, respectively, for detection of these lesions. Gastric wall thickening that was 1 cm or greater and was focal, eccentric, and enhancing had a specificity of 92% but a sensitivity of only 36% for detection of these lesions. CONCLUSION: Gastric wall thickness of 1 cm or greater at CT had a sensitivity of 100% but a specificity of less than 50% for detection of malignant or potentially malignant stomach lesions that necessitated further diagnostic evaluation.     

Gastric pneumatosis: the role of CT in diagnosis and patient management

Gastric pneumatosis is rare, with causes ranging from benign to lethal. The purpose of this pictorial essay is to present a series of cases of gastric pneumatosis, review the causes, and demonstrate how computed tomography (CT) can help guide management. A range of primary gastric pathology can cause air in the wall of the stomach. However, gastric pneumatosis may reflect intraabdominal pathology arising from other hollow viscera, with indicators of the extragastric etiology on CT.     

充气法MSCT动态增强对胃癌的诊断价值

目的探讨全胃充气法多层CT动态增强在胃癌诊断中的应用价值。方法上消化道钡餐及胃镜检查拟诊胃癌17例患者,以充气法行全胃16层CT增强扫描检查,并同手术病理对比。结果17例患者均行部分或全胃切除及区域淋巴结清扫术,病理证实胃腺癌15例,其术前全胃充气法多层CT增强扫描中局限隆起病灶11例,弥漫性增厚病变4例,病灶之CT呈现持续均匀强化,强化程度以门静脉期达最高;黏液腺癌2例,病变主要位于胃窦部,胃壁弥漫性增厚且密度不均匀,CT增强动脉期强化不明显,门静脉期呈"三明治"样强化表现。结论全胃充气法MSCT动态增强扫描对胃癌定位、定性诊断具有很高价值。     

胃扩张对大鼠中枢和外周神经系统c -fos和外周降钙素基因相关肽mRNA表达的影响

 目的 探索大鼠伤害性胃扩张后内脏刺激传入的途径和部位,了解外周降钙素基因相关肽(Calcitonin gene-related peptide,CGRP)在内脏刺激传入过程中发挥的作用.方法 成年SD雄性大鼠,随机分为实验组(12只)、手术对照组(6只)和空白对照组(6只).实验组、手术对照组先予置入胃内气囊.48h后,实验组接受反复的气囊扩张(80 mmHg),2 h后处死全部实验动物,立即取材(胃壁、脊髓T8～10和脑).利用荧光定量PCR进行c-fos mRNA和CGRP mRNA的定量分析.结果 实验组杏仁核、延髓、胸髓和胃窦组织c-fos表达较其他两组明显增强(P＜0.05).实验组胃窦、胸髓和延髓CGRP表达显著增强(P＜0.05).胸髓和延髓CGRP与c-fos表达相关(rs分别为0.778和0.774,P＜0.05).结论 胃扩张刺激可以兴奋杏仁核等皮质下中枢,CGRP参与内脏刺激信号的传入过程.     

胃癌双能量扫描在分期中的应用

目的 探讨胃癌双能量CT优化图像质量,评估其在胃癌术前分期中的作用.方法 收集临床疑有胃癌的患者55例,行双源双能量腹部增强扫描.测量100 kV、70 keV、120 kV图像病灶动静脉期的CT值,信噪比(SNR)、噪声.选择出最佳水平的图像,并评估此水平图像的术前TNM分期,并和常规120 kV图像相对比.结果 动静脉期70 keV和100 kV图像强化程度均高于120 kV(P＜0.001);动脉期70 keV和120 kV的SNR高于100 kV(P＜0.01),静脉期70 keV的SNR高于120 kV和100 kV(P＜0.01);70 keV和120 kV T分期符合率分别为83.7％、72.1％(P=0.25);120 kV和70 keV N分期符合率分别为62.8％、74.4％ (P＜0.05).结论 双能量CT 70 keV单能图像较常规120 kV优化了图像质量,提高了N分期的符合率.     

Gastric mucosa-associated lymphoid tissue lymphoma: helical CT findings and pathologic correlation

OBJECTIVE: The purpose of this study was to describe helical CT findings of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to correlate them with pathologic findings. MATERIALS AND METHODS: We retrospectively reviewed CT examinations of 58 patients with confirmed gastric MALT lymphomas. Using the histopathologic grade of the MALT lymphomas, we divided the patients into two groups: those with high-grade lymphoma (n = 21) and those with low-grade lymphoma (n = 37). Common CT findings for the two groups were reviewed and compared. RESULTS: Forty (69%) of the 58 patients showed at least one abnormality of the stomach on CT. Abnormalities included diffuse or segmental gastric wall thickening (66%, 38/58), lymphadenopathy (40%, 23/58), ulcer (22%, 13/58), and gastric mass (3%, 2/58). Eighteen (31%) of 58 patients were found to have no abnormality. The high-grade group had a higher incidence of abnormalities seen on CT than the low-grade group (100% vs 51%, respectively). Gastric wall thickening in the high-grade group was more diffuse (48% vs 8%) and severe (71% vs 14%; severe or moderate) than that seen in the low-grade group. Lymphadenopathy was visualized in 67% of the high-grade group and in 24% of the low-grade group. Gastric ulcer was found in 57% of the high-grade group and in only 5% of the low-grade group. The gastric mass formation was seen in only two patients in the high-grade group. CONCLUSION: The CT findings of gastric MALT lymphoma that the two groups had in common were gastric wall thickening and lymphadenopathy. Although our results pointed to no specific CT finding for differentiating high-grade from low-grade gastric MALT lymphomas, we found that the absence of abnormality on CT is highly predictive of low-grade MALT lymphoma.     

进展期胃癌介入治疗疗效分析

目的研究进展期胃癌的介入治疗及疗效。方法对212例进展期胃癌进行介入治疗。对贲门癌经胃左动脉和左膈下动脉或脾动脉进行化疗灌注和胃左动脉栓塞;对胃体小弯侧癌经胃左、右动脉或肝总动脉,对胃大弯侧癌经胃十二指肠动脉、胃网膜右动脉或脾动脉化疗灌注;对胃窦癌经胃十二指肠动脉或对胃网膜右动脉中段栓塞后进行化疗药物灌注。对胃癌复发和残胃癌经腹腔干和肠系膜上动脉化疗灌注。结果对未手术的193例胃癌的疗效为贲门癌CR PR53.1%,胃体癌CR PR44.4%,胃窦癌CR PR10.0%,胃癌复发和残胃癌CR PR0。贲门癌与胃体癌有效率相比(P>0.25),两者差异无统计学意义。贲门癌与胃窦癌相比及胃体癌与胃窦癌相比,差异有统计学意义(P值均<0.05)。介入治疗后手术切除者术后1、2年生存率分别为81%、56%。结论胃癌在胃组织的发病部位不同,其疗效也不同,贲门癌和胃体癌的疗效较好,胃窦癌及胃癌复发和残胃癌疗效较差。