进展期胃癌和胃淋巴瘤的MSCT影像学鉴别

目的：分析探讨多层螺旋CT（MSCT）在进展期胃癌和胃淋巴瘤鉴别诊断中的价值。方法对46例进展期胃癌和34例胃淋巴瘤患者的MSCT平扫和增强扫描影像学资料进行分析,比较两种肿瘤在胃侵犯部位、胃壁胃黏膜及胃腔改变、周围组织及器官的浸润或转移、中上腹部淋巴结转移等方面的差异。结果进展期胃癌组多部位侵犯14例,增强扫描不均匀强化28例,胃黏膜中断、破坏24例,胃腔狭窄、近侧胃腔扩张14例,腹主动脉周围下部淋巴结转移18例;胃淋巴瘤组多部位侵犯24例,增强扫描不均匀强化7例,胃黏膜中断、破坏5例,胃腔狭窄、近侧胃腔扩张3例,腹主动脉周围下部淋巴结转移23例;两组上述指标差异均有统计学意义（P＜0.05或P＜0.01）。进展期胃癌组和胃淋巴瘤组在胃壁厚度、肿瘤外侵和器官转移、平均淋巴结转移的部位数等差异无统计学意义（P＞0.05）。结论 MSCT可清晰显示进展期胃癌和胃淋巴瘤的侵犯部位、侵犯程度的不同,对于二者的鉴别具有重要价值。     

原发性胃淋巴瘤气钡造影X线及螺旋CT表现

 目的　探讨原发性胃淋巴瘤上消化道造影X线及螺旋CT的表现特征,以提高对其诊断的准确率。方法　回顾分析经手术及病理确诊的24例原发性胃淋巴瘤患者的临床资料、螺旋CT及上消化道造影表现,总结其特点。结果　24例患者均为B细胞起源的非霍奇金淋巴瘤。螺旋CT主要表现为多灶分布,密度均匀,均匀强化,胃壁广泛显著增厚但柔软,胃周多区淋巴结肿大。上消化道造影表现为病灶多样、复杂,多发或单发结节,多发浅表溃疡,胃壁弥漫性增厚但胃壁蠕动存在且胃腔无缩小。结论　原发性胃淋巴瘤螺旋CT及上消化道造影表现具有一定的特征,对原发性胃淋巴瘤的诊断及鉴别具有重要意义。     

原发性胃淋巴瘤的X线和CT诊断

目的:提高原发性胃淋巴瘤(PGML)的X线和CT诊断水平。方法:收集21例经胃镜活检和手术证实为原发性胃淋巴瘤。其中行胃肠气钡双对比造影(GI)检查7例,CT检查17例,两者均行检查3例。分析其GI和CT表现。结果:21例PGML中,GI表现为多发结节状充盈缺损5例,胃底、体多发肿块1例,胃腔扩张及收缩良好5例。CT表现为胃壁增厚17例,伴有肿块4例,形成直径2.5cm以上大溃疡4例。17例胃壁均增厚为0.6cm～4cm,14例(82.3%)增厚胃壁增强幅度为14HU～25HU的轻、中度强化。增厚胃壁强化均匀15例,见小片状坏死2例。肝脏均未见转移性病灶。结论:原发性胃淋巴瘤主要位于胃窦和胃体,GI主要表现为多发结节状充盈缺损或多发肿块,CT主要表现为浸润型,密度均匀,呈轻、中度均匀强化,可伴有大溃疡形成,在GI检查或CT三期扫描中胃的形态可变。     

术前低张力水充盈胃薄层CT扫描30例进展期胃癌诊断的临床价值分析

[目的]探讨术前低张力水充盈胃薄层CT扫描在进展期胃癌中的临床价值。[方法]30例进展期胃癌术前行低张力水充盈胃薄层CT扫描,并与术后病理对照分析。[结果]30例CT扫描示胃壁厚度5～25mm,术后病理为8～28mm。CT检查15例淋巴结转移,术后病理18例淋巴结转移。术后证实6例周围脏器侵犯,CT准确率为85.7%。[结论]低张力水充盈胃薄层CT扫描可了解病变的侵犯范围及转移情况,对确定肿瘤分期、提供治疗方案起重要的作用。     

29例弥漫浸润型胃癌的X线与超声表现

报告２９例经手术病理确诊的弥漫浸润型胃癌的Ｘ线与超声征象。典型Ｘ线表现为胃腔缩小、壁僵硬、粘膜破坏中断；超声特点为胃壁增厚、层次结构消失、与相邻组织间的境界回声消失及区域淋巴结肿大等。一对显示病变部位、病变范围、胃腔狭窄程度、胃壁僵硬度、粘膜破坏、蠕动功能异常等精确，定性诊断符合率高；超声对观察肿瘤的浸润深度、周围侵犯及淋巴转移等情况下很可靠，利于制定治疗方案，弥补了Ｘ线检查的不足。     

29例弥漫浸润型胃癌的X线与超声表现

报告２９例经手术病理确诊的弥漫浸润型胃癌的Ｘ线与超声征象。典型Ｘ线表现为胃腔缩小、壁僵硬、粘膜破坏中断；超声特点为胃壁增厚、层次结构消失、与相邻组织间的境界回声消失及区域淋巴结肿大等。认为Ｘ线对显示病变部位、病变范围、胃腔狭窄程度、胃壁僵硬度、粘膜破坏、蠕动功能异常等精确，定性诊断符合率高；超声对观察肿瘤的浸润深度、周围侵犯及淋巴转移等情况很可靠，利于制定治疗方案，弥补了Ｘ线检查的不足。     

CT扫描在胃癌诊断方面的应用

胃癌的诊断主要以胃双重造影和纤维胃镜检查为主，从胃腔内粘膜面观察病变求得质的诊断，但对粘膜下层以下的深层胃壁和其他脏器浸润情况的诊断有一定限度。近年来随着新的影像诊断器械的开发及诊断技术的进步，使进行期胃癌的诊断和进展程度在术前可以得到判断。为了制定合理而且有效的治疗方针，术前准确把握胃癌的浸润深度，淋巴结转移，肝转移，腹膜播种及远隔转移等情况是非常必要的。本文作者结合临床病例对CT扫描在胃癌量诊断方面价值进行初步探讨。对象和方法1990年11月一1991年间我科施行手术治疗的胃癌病例中有146例术前施行CT…     

MSCT及其后处理技术对胃癌的诊断价值

目的 探讨多层螺旋CT（MSCT）在胃癌术前临床分期中应用价值.方法 对43例经胃镜及术后证实的胃癌患者行术前MSCT扫描,所得图像进行MPR、CTVE、SSD及Raysum重建,观察胃癌病灶大小、位置、侵犯胃壁深度及侵犯胃周器官的范围、胃周淋巴结大小及远处转移;按国际统一的TNM分期法进行术前CT分期,其结果 与术后病理TNM分期对照.结果 MSCT对胃癌T分期的总准确率为83.7%（36/43）;对N分期的总准确率为72.1%（31/43）;对M分期的总准确率为93.0%（40/43）.结论 通过MSCT的多种后处理方式的相互结合,能全方位显示胃腔内、外病灶,能提高胃癌TNM分期的准确率,是胃癌术前分期的可靠方法,对外科制定合理的治疗方法 有较高的价值.     

CT诊断胃癌的临床价值

目的评价CT检查在胃癌诊断中的临床价值.方法43例胃癌均经手术及病理证实,CT图像的分析结果与手术及病理所见进行对照分析.结果CT判断胃周邻近器官受侵的准确性为90.99%,判断肝转移的准确性为88.37%,CT检出肿大淋巴结23例,与手术病理的符合率为71.88%.结论CT有助于进展期胃癌的诊断,对判断胃周壁外侵犯、远处脏器转移、肿大淋巴结的存在具有重要作用.     

近侧胃癌胃裸区受侵及淋巴结转移的手术前判断及临床价值

目的:研究近侧胃癌(PGC)侵犯胃裸区(GBA)的术前诊断及临床意义。方法:回顾性分析37例PGC病人的CT、B超及病理等临床资料,并经手术证实是PGC侵犯GBA,观察其术前影像特征,分析其解剖基础。结果:37例CT及B超表现为肿瘤侵犯GBA内可见不均匀强化的软组织肿块,腹膜后淋巴结肿大或融合成团,左膈肌脚或胃膈韧带不规则增厚并与肿瘤分界不清。结论:PGC侵犯GBA术前能够作出正确判断对于手术方案的制订及术中癌灶的完整切除、相关淋巴结的彻底清扫有重要的临床价值,从而改善PGC的预后。     

不同分化程度胃癌的多排螺旋CT表现特点

目的 探讨不同分化程度胃癌的多排螺旋CT表现特点.方法 收集经手术病理证实的230例胃癌患者,分析不同分化程度胃癌的病灶大体形态、病灶强化程度及淋巴结CT影像学特点,并与病理结果 对照.结果蕈样型胃癌181例(78.70%),溃疡型胃癌24例(10.42%),息肉型胃癌18例(7.83%),弥漫型胃癌7例(3.05%).胃癌诊断准确率为98.26%.弥漫型胃癌中没有高分化腺癌,低分化腺癌和中分化腺癌共占82.35%.CT大体形态不同分化程度胃癌差异无统计学意义(P>0.05).胃癌病灶平扫及动脉期CT值各分化组间差异无统计学意义(P>0.05),静脉期及延迟期各分化组间差异具有统计学差异(P<0.05).高分化胃癌病灶的CT值在静脉期和延迟期明显小于低分化和中低分化腺癌(P<0.05).通过测量淋巴结短径CT共检出≥6 mm淋巴结556枚,≥8 mm淋巴结290枚,≥10 mm淋巴结229枚.不同分化程度胃癌组织淋巴结平扫及三期增强CT值比较,差异无统计学意义(P>0.05).结论 CT中低分化及低分化胃腺癌病灶的强化程度,高于高分化及中分化胃腺癌,强化峰值在静脉期和延迟期.     

Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10

Background Knowledge regarding the presence and location of lymph node metastasis in gastric cancer is essential in deciding on the operative approach. Lymph node metastases have been diagnosed with imaging tests such as computed tomography (CT) and ultrasonography (US); however, the accuracy of such diagnoses, based on size and shape criteria, has not been adequate. Ferumoxtran-10 (Combidex; Advanced Magnetics) is a lymphotropic contrast agent for magnetic resonance imaging (MRI) whose efficacy for the detection of metastatic lymph nodes in various cancers has been reported by several investigators; however, its efficacy for this purpose has not been reported for gastric cancer. We investigated the efficacy of ferumoxtran-10-enhanced MRI for the diagnosis of metastases to lymph nodes in gastric cancer. Methods Seventeen consecutive patients who were diagnosed with a nonearly stage of gastric cancer were enrolled in the study. All the patients were examined by MRI (Signa Horizon 1.5 T; GE Medical; T2*-weighted images) before and 24 h after the intravenous administration of ultrasmall particles of superparamagnetic iron oxide — ferumoxtran-10 (2.6 mg Fe/kg of body weight) — and the presence or absence of metastasis was determined from the enhancement patterns. The imaging results were compared with the corresponding histopathological findings following surgery. Results Of 781 lymph nodes dissected during surgery, the imaging results of 194 nodes could be correlated with their histopathological findings. Fifty-nine lymph nodes from 11 patients had histopathological metastases. In nonaffected normal lymph nodes, we observed dark signal intensity on MRI caused by the diffuse uptake of the contrast medium by macrophages resident in the lymph nodes, which phagocytose the iron oxide particles of ferumoxtran-10. The number of phagocytic macrophages was decreased in metastatic lymph nodes, and they showed various patterns of decreased uptake of ferumoxtran-10. Three enhancement patterns were observed in lymph nodes: (A) lymph nodes with overall dark signal intensity due to the diffuse uptake of ferumoxtran-10; (B) lymph nodes with partial high signal intensity due to partial uptake; and (C) no blackening of lymph nodes due to no uptake of ferumoxtran-10. Patterns (B) and (C) were defined as metastatic. The sensitivity, specificity, positive predictive value, negative predictive value, and overall predictive accuracy of postcontrast MRI were 100% (59/59), 92.6% (125/135), 85.5% (59/69), 100% (125/125), and 94.8% (184/194), respectively. These parameters for predictive accuracy were much superior to these parameters previously evaluated by CT or US. Nodes in the retroperitoneal and paraaortic regions were more readily identified and diagnosed on the MR images than those in the perigastric region. Conclusion The present study confirmed that ferumoxtran-10-enhanced MRI is useful in the diagnosis of metastatic lymph nodes and that the use of this modality will be helpful in treatment decision-making for gastric cancer patients.     

胃癌淋巴结微转移的多种抗体联合检测及其临床价值

免疫组化法检测胃癌淋巴结中的微转移灶方法简便,但敏感性差。同时应用多种抗体联合检测淋巴结的微转移情况,是否能提高其敏感性,克服免疫组化法的弱点尚有一些争议。本研究应用细胞角蛋白20(CK20)、上皮膜抗原(EMA)及肿瘤相关糖蛋白72-4(CA72-4)抗体对胃癌阴性淋巴结的微转移情况进行联合检测,旨在评价多种抗体联合检测微转移的应用价值。     

胃癌术后复发转移的超声检查

目的探讨超声检查在胃癌术后随访中的临床意义.方法回顾分析251例胃癌根治术后1个月至10年胃内外复发和转移者的随访性超声检查资料.结果残胃复发56例(22.3%),腹腔淋巴结转移59例(23.5%),浅表淋巴结转移11例(4.4%),腹水64例(25.5%),腹壁转移9例(3.6%),肝转移61例(24.3%),卵巢转移7例(2.8%),胰腺及后腹膜转移32例(12.7%),脾转移3例(1.2%),门静脉癌栓3例(1.2%),下腔静脉癌栓2例(0.8%),肾转移1例(0.4%),甲状腺转移1例(0.4%).结论超声检查在胃癌术后随访中能比较及时发现胃内外复发和转移病灶,为胃癌术后抗复发治疗提供影像学依据.     

Involvement of Abdominal and Pelvic Lymph Nodes in Non-Hodgkin Lymphoma： the Nodal Distribution in Chinese Patients

Objective To study the distribution of abdominal and pelvic lymphadenopathy in non-Hodgkin lymphoma (NHL) in Chinese patients. Methods CT images of 241 NHL patients with abdominal and/or pelvic lymphadenopathy were reviewed. Among them, clinical and image data from 96 patients fulfilled the requirements for the analysis: 1. Abdominal and/ or pelvic lymphadenopathy detected by CT in untreated patients (n=74). 2. Recurrent patients: new lesions in abdominal or pelvic lymph nodes who never had any nodular lesion by previous abdominal and/or pelvic CT (n = 14). 3. Treated patients who did not have abdominal and/or pelvic CT previously, showed regression of initial disease for at least 6 months after chemotherapy and subsequently showed abdominal and/or pelvic lymphadenopathy (n=8). According to the Clinical Schema for Lymphoid Tissue, these patients were divided into 3 histologic subtypes: indolent (IL; n=31), aggressive (AL; n=61) and very aggressive (VAL; n=2) lymphoma. The remaining 2 cases were unclassified lymphoma (UCL). Both abdominal and pelvic CT scans were undertaken in 46 patients, abdominal CT only in 47 patients and pelvic CT only in 3 patients. Enhanced CT was obtained in 80 patients. The anatomic sites involved were designated as retroperitoneal (ie. paraaortic), mesenteric, abdominal (i.e. celiac, paracardiac, gastrohepatic and hepatic hilum, etc.), retrocrural, subdiaphragmatic, common iliac, internal iliac, external iliac and inguinal nodes respectively. Results The lesions located in the retroperitoneum were most common for IL and AL, the incidences being 83.3% (18/25) and 83.1% (49/59) respectively, results being similar. Among those, lymphadenopathy distributed mainly in the retroperitoneum, superior and inferior renal hila, with an incidence of 72.0% (18/25) in IL and 67.3% (33/49) in AL. Pelvic lymphadenopathy came next, with the overall incidence of 41.9% (126/301), 57.5% (50/87) in IL and 35.5% (76/214) in AL respectively. Mesenteric lymph nodes stood third with the overall incidence of 37.1 % (33/89), 43.3% (13/30) in IL and 33.9% (20/59) in AL. Statistical analysis showed that external iliac lymph node involvement to be more common in IL than in AL (P<0.05), while comparisons of other groups showed no statistical significance. Conclusion For Chinese NHL patients, retroperitoneal lymph nodes were mostly involved, followed by iliac and mesenteric lymphadenopathy, which was different from that of the Western countries. The involved retroperitoneal lymph nodes in NHL of Chinese patients were predominantly located in the superior and inferior renal hilum.     

双源CT双能量扫描融合三维重建技术在诊断胃癌及淋巴结中应用的研究

目的 本研究探讨双源CT双能量增强扫描获得的参数能否区分胃癌病灶与正常胃壁,以确定病变范围,提高早期胃癌符合诊断率,精准N分期。方法 通过西门子Somatom Definition Flash双源CT对术前胃癌患者进行双能量增强扫描,将采集的数据经Syngo.Via软件分析及三维重建,获得胃癌病灶、正常胃壁、转移淋巴结与非转移淋巴结的绝对碘值、标准化碘值及虚拟单能量能谱曲线的斜率并记录,结合术后病理结果,应用统计学方法分析判断两两之间的差异。结果 胃癌病灶的绝对碘值为(3.329±0.812)g/L,标准化碘值为(64.006±17.450)%,虚拟单能量能谱曲线的斜率为(-2.916±1.3227),与正常胃壁的绝对碘值(1.563±0.708)g/L,标准化碘值(37.122±16.267)%,虚拟单能量能谱曲线的斜率(-1.621±1.4028)比较,均存在统计学差异(P＜0.05);转移淋巴结的绝对碘值为(2.968±0.547)g/L,标准化碘值为(63.597±14.633)%,虚拟单能量能谱曲线的斜率为(-2.532±0.753),与非转移淋巴结绝对碘值(1.465±0.408)g/L,标准化碘值(35.240±14.357)%,虚拟单能量能谱曲线的斜率(-1.378±0.726)比较,均存在统计学差异(P＜0.05)。结论 双源CT双能量扫描获得的参数结合三维重建技术有助于确定病变范围,提高早期胃癌的符合诊断率,区分转移淋巴结与非转移淋巴结以提高N分期的准确率。     

逆行腹膜后入路托出式脾门淋巴结清扫术研究

目的探讨一种新的脾门淋巴结清扫方式,分析如何在安全的前提下彻底清除脾门淋巴结。方法对80例采用逆行腹膜后入路托出式脾门淋巴结清扫的患者（新术式组）进行回顾性分析,将其基本资料和病理结果与同期常规手术组113例患者资料相比较。结果新术式组脾门淋巴结清扫总数519枚,阳性淋巴结数65枚,第10组淋巴结阳性率为12．5％。1例患者因术后脾门小血管渗血,行二次手术切除脾脏;常规手术组清除总淋巴结数565枚,阳性淋巴结数58枚,第10组淋巴结阳性率为10．3％。两组清扫淋巴结阳性率差异有统计学意义,全组无死亡病例。结论逆行腹膜后入路托出式脾门淋巴结清扫可以安全、彻底地清除脾门淋巴结。     

逆行腹膜后入路托出式脾门淋巴结清扫研究

 目的　报道一种新的脾门淋巴结清扫方式,分析如何在安全的前提下彻底清除脾门淋巴结。方法　对80例采用逆行腹膜后入路托出式脾门淋巴结清扫的患者（新术式组）进行回顾性分析,将其基本资料和病理结果与同期常规手术组113例患者资料相比较。结果　新术式组脾门淋巴结清扫总数519枚,阳性淋巴结数65 枚,No.10 组淋巴结阳性率为12.5 %。1例患者因术后脾门小血管渗血,行二次手术切除脾脏;常规手术组清除总淋巴结数565枚,阳性淋巴结数58枚,No.10 组淋巴结阳性率为10.3 %。两组清扫出淋巴阳性率差异有统计学意义。全组无死亡病例。结论　逆行腹膜后入路托出式脾门淋巴结清扫可以安全、彻底地清除脾门淋巴结。     

Multiparametric in situ mRNA hybridization analysis of gastric biopsies predicts lymph node metastasis in patients with gastric carcinoma.

We examined the expression level of several genes that regulate different steps in metastasis formation in formalin-fixed, paraffin-embedded biopsies of 189 primary human gastric carcinomas prior to surgical resection in patients in whom lymph node metastasis was not evident by endoscopic ultrasound or computed tomography (CT) scan. The expressions of epidermal growth factor receptor (EGF-R), vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2 and E-cadherin were examined by a colorimetric in situ mRNA hybridization technique. The integrity of the mRNAs was verified, leaving 161 (85.2%) patients for study. After gastrectomy, 82 patients had positive lymph nodes and 79 patients had negative lymph nodes. The concurrent expression levels of MMP-2 and E-cadherin mRNAs were significantly higher and lower, respectively, in the metastatic tumors than the non-metastatic tumors. Expression of EGF-R and VEGF was not different between the metastatic and non-metastatic tumors. However, when only the intestinal-type of gastric cancer was evaluated, the level of VEGF mRNA was significantly higher in tumors associated with lymph node metastasis than in those without metastasis. However, a high MMP-2:E-cadherin ratio significantly correlated with lymph node metastasis in both types of gastric cancer. These results suggest that multiparametric in situ hybridization analysis for several metastasis-related genes may allow the preoperative prediction of lymph node metastasis from gastric cancer.