腹部电子计算机断层扫描在胃癌壁外血管侵犯评估中的应用价值

目的探讨腹部电子计算机断层扫描(CT)在胃癌壁外血管侵犯评估中的应用价值。方法选取原发性胃癌患者98例,均行腹部CT检查。以手术病理检查结果为金标准,分析腹部CT诊断胃癌壁外血管侵犯的价值。比较壁外血管侵犯和未侵犯者TNM分期及肿瘤大小和生长方式。结果腹部CT诊断胃癌壁外血管侵犯结果与手术病理结果的一致性较高(Kappa=0. 953,P=0. 001);腹部CT诊断胃癌壁外血管侵犯的准确性为97. 96%(96/98),敏感性为100. 00%(30/30),阳性预测值为93. 75%(30/32),特异性为97. 06%(66/68),阴性预测值为100. 00%(66/66)。胃癌壁外血管侵犯及未侵犯者N分期及M分期比较,差异无统计学意义(P 0. 05);与未发生壁外血管侵犯者比较,壁外血管侵犯者T分期中T4分期所占比例较高,差异有统计学意义(P 0. 05)。与壁外血管未侵犯者比较,壁外血管侵犯者肿瘤 5 cm及近端结节型加弥漫型所占比例较高,差异有统计学意义(P 0. 05)。结论腹部CT可提高胃癌壁外血管侵犯的术前评估效果,准确判断胃癌壁外血管侵犯疾病。     

CT浆膜高强化征鉴别诊断T3期与T4a期胃癌

目的 探讨CT所示浆膜高强化征鉴别诊断T3期与T4a期胃癌的价值。方法 回顾性分析104例经手术病理证实的胃癌T3期或T4a期患者术前腹部三期增强扫描CT图像,观察并比较各期图像浆膜高强化征的出现率。以出现浆膜高强化征为诊断T4a期的标准,计算浆膜高强化征诊断T4a期胃癌的准确率、敏感度、特异度、阳性预测值和阴性预测值。结果 104例胃癌患者中,T3期34例,T4a期70例。浆膜高强化征判断T4a期胃癌的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为77.88%（81/104）、81.43%（57/70）、70.59%（24/34）、85.07%（57/67）及64.86%（24/37）。T4a期胃癌动脉期、静脉期及实质期浆膜高强化征出现率分别为32.86%（23/70）、75.71%（53/70）、62.86%（44/70）,动脉期与静脉期（P<0.001）、动脉期与实质期（P=0.001）间差异有统计学意义,静脉期与实质期之间差异无统计学意义（P=0.143）。结论 浆膜高强化征诊断胃癌T4a期具有较高准确率、敏感度及特异度,可用于判断胃癌浆膜受侵,推荐在静脉期或实质期观察该征象。     

CT和纵隔镜在肺癌术前分期中的优势与局限性分析(附163例报告)

目的探讨CT和纵隔镜在肺癌术前分期中的优势及其局限性。方法163例术前高度怀疑或已确诊为肺癌的患者,行胸CT和经颈纵隔镜检查术和/或扩大经颈纵隔镜检查术,对适合手术的108例患者行开胸手术和淋巴结清扫,然后比较CT和纵隔镜术对判断纵隔淋巴结转移的敏感度、特异度、准确率、阳性和阴性预测值;CT判断纵隔淋巴结阳性的标准为淋巴结短径≥1.0cm,长径≥1.5cm。结果CT检查对判断纵隔淋巴结转移的敏感度为74.4%,特异度为75.4%,准确率75.0%,阳性预测值63.0%,阴性预测值为83.9%。纵隔镜检查对判断纵隔淋巴结转移的敏感度为94.9%,特异度为100%,准确率96.3%,阳性预测值100%,阴性预测值97.2%。纵隔镜检查对判断纵隔淋巴结转移的敏感度、特异度、准确率、阳性预测值和阴性预测值等均明显优于CT检查(P<0.05、P<0.01)。结论纵隔镜对判断肺癌纵隔淋巴结转移明显优于CT,而且安全,具有无创性,易被患者接受,是术前的必要检查方法。     

双能量成像测量胃癌胃周脂肪组织碘含量判断浆膜受侵

目的 探讨应用双能量成像测量胃癌患者胃周脂肪组织碘含量判断浆膜受侵的价值。方法 回顾性分析48例胃癌患者的术前双源CT双能量扫描图像,测量并比较双能量动脉期、静脉期浆膜受侵（n=32）与未受侵（n=16）胃周脂肪组织碘含量,采用ROC曲线法评价其判断胃癌浆膜受侵的能力。结果 动脉期、静脉期浆膜受侵胃癌浆膜面脂肪组织碘含量均高于浆膜未受侵（动脉期：0.6 mg/ml vs 0,Z=－4.24,P<0.001;静脉期：0.70 mg/ml vs 0.30 mg/ml,Z=－4.29,P<0.001）。动脉期曲线下面积（AUC）值为0.87,碘含量界值为0.25 mg/ml时,敏感度为84.4%,特异度为81.2%;静脉期AUC值为0.88,碘含量界值为0.45 mg/ml时,敏感度为87.5%,特异度为81.2%。结论 应用双能量成像测量胃癌胃周脂肪组织碘含量能够较为准确地判断胃浆膜有无受侵。     

CT与MRI在术前诊断直肠癌淋巴结转移的临床价值对比

目的:分析CT与MRI在术前诊断直肠癌淋巴结转移的临床价值。方法:选取我院2015年12月~2017年03月收治的81例直肠癌患者为研究对象,所有患者在术前均进行CT(CT组)与MRI(MRI组)检查,并以术后病理诊断为参考标准,将其作为对照组。对比三组诊断情况,分析CT与MRI诊断淋巴结转移的特征。结果:CT组的敏感度、特异度、准确度、阳性及阴性预测值与MRI组相比,差异没有统计学意义(P0.05)。CT组中,恶性淋巴结患者的淋巴结数(7.90±1.30)个、淋巴结大小(0.66±0.10)cm、短长经比值(0.85±0.09)和良性淋巴结患者的比较明显升高;MRI组中,恶性淋巴结患者的肠周脂肪混杂信号征(82.26%)、浆膜面浸润(69.35%)、静脉包绕征所占比例(88.71%)和良性淋巴结患者的比较明显升高,差异具有统计学意义(P0.05)。结论:CT与MRI均能够真实、准确反映出等淋巴结数、淋巴结大小以及浆膜面浸润等直肠癌淋巴结转移情况,协助临床医生对该疾病进行确诊,有较好的敏感度、特异度以及较高的准确性,值得临床上应用。     

直肠癌术前CT诊断与术后病理对照研究

目的 探讨CT检查在直肠癌术前诊断中的临床应用价值.方法 回顾性分析经手术病理证实的67例直肠癌患者的CT表现,其中男38例,女29例,与术后病理结果 进行对照,分析CT分期和病理分期中的各项准确性指标,评价CT检查的临床价值.结果 直肠充气CT扫描对67例直肠癌患者的诊断准确率为100%;诊断直肠癌侵犯浆膜外脂肪的阳性预测值、阴性预测值、敏感度、特异度、假阳性、假阴性分别为94.6%、72.7%、94.6%、72.7%、27.3%、5.4%;诊断盆腔区域淋巴结转移的阳性预测值、阴性预测值、敏感度、特异度、假阳性、假阴性分别为74.2%、69.4%、67.6%、75.8%,24.2%、32.4%;CT分期和病理分期Ⅰ-Ⅲ期的符合率分别为75.0%、68.8 oA、74.2%,总符合率为71.6%.结论 CT检查 能准确的检出直肠癌,并能准确的显示浆膜外脂肪的侵犯,但直肠癌的CT分期和对淋巴结转移的判定仍有限制.     

GOLPH3、VEGF在胃癌组织中的表达情况及其临床意义

目的 探讨高尔基体磷酸化蛋白3(GOLPH3)、血管内皮生长因子（VEGF）在胃癌组织中的表达情况及其临床意义。方法 选取2018年2月—2019年3月于河北北方学院附属第一医院行胃癌根治性切除手术的103例患者作为研究对象,分析所选患者的临床资料,收集其胃癌组织及癌旁组织。比较不同TNM分期、浸润深度、分化程度、淋巴结转移胃癌患者GOLPH3、VEGF表达情况。结果胃癌组织GOLPH3、VEGF阳性表达率分别为66.02%、58.25%,均高于癌旁组织的19.42%、23.30%(P<0.05)。TNM分期为Ⅲ/Ⅳ期胃癌患者GOLPH3、VEGF阳性表达率分别为91.11%、88.89%,均高于Ⅰ/Ⅱ期的46.55%、34.48%(P<0.05)。侵犯浆膜胃癌患者GOLPH3、VEGF阳性表达率分别为87.69%、69.23%,均高于未侵犯浆膜的28.95%、39.47%(P<0.05)。低分化胃癌患者GOLPH3、VEGF阳性表达率分别为82.54%、79.37%,均高于中/高分化的40.00%、25.00%(P<0.05)。发生淋巴结转移胃癌患者GOLPH...     

超声造影评估胰腺癌胰周动静脉侵犯的临床价值CSCD

目的评价超声造影(CEUS)诊断胰腺癌侵犯胰周动脉或静脉的临床应用价值。方法选取2013年1月至2017年3月在浙江大学医学院附属第二医院就诊的94例经手术病理证实的胰腺癌患者的超声造影资料,观察各病灶超声造影增强特征,判断病灶周围动静脉是否侵犯,并将超声诊断结果与术后病理作对比分析。胰周动脉受侵的CEUS诊断标准为动脉被肿瘤包埋或肿瘤包绕动脉且管壁浸润或管腔狭窄。胰周静脉受侵的CEUS诊断标准为肠系膜上静脉、门静脉被肿瘤包绕、狭窄、扭曲或闭塞。结果经手术病理诊断的94例胰腺癌患者,其中胰头癌62例,胰腺体尾部癌32例,超声造影6例(6.4%)表现为实质期不均匀高增强,78例(83%)表现为实质期呈不均匀低增强,10例(10.6%)表现为实质期不均匀等增强。CEUS诊断CA受侵25例(26.6%),未受侵69例(73.4%),其诊断的敏感度、准确性、特异度、阳性预测值、阴性预测值分别为63.6%、79.7%、84.7%、56.0%、88.0%。CEUS诊断肠系膜上动脉(SMA)受侵27例(28.7%),未受侵67例(71.3%),其诊断的敏感度、准确性、特异度、阳性预测值、阴性预测值分别为66.6%、77.6%、80.2%、44.0%、91.0%。CEUS诊断PV受侵27例(28.7%),未受侵67例(71.3%),其诊断敏感度、准确性、特异度、阳性预测值、阴性预测值分别86.6%、94.6%、98.4%、96.2%、94.0%;CEUS诊断SMV受侵26例(27.6%),未受侵68例(72.4%),其诊断敏感度、准确性、特异度、阳性预测值、阴性预测值分别为75.0%、87.2%、92.4%、80.7%、89.7%。结论 CEUS作为一种安全、无创、相对廉价的有效诊断方法,对胰腺恶性肿瘤的诊断及对胰周血管侵犯的评估有较高的临床应用价值,可对能否行外科手术切除作出术前评估,值得临床推广应用。     

超声造影评估胰腺癌胰周动静脉侵犯的临床价值

目的评价超声造影(CEUS)诊断胰腺癌侵犯胰周动脉或静脉的临床应用价值。方法选取2013年1月至2017年3月在浙江大学医学院附属第二医院就诊的94例经手术病理证实的胰腺癌患者的超声造影资料,观察各病灶超声造影增强特征,判断病灶周围动静脉是否侵犯,并将超声诊断结果与术后病理作对比分析。胰周动脉受侵的CEUS诊断标准为动脉被肿瘤包埋或肿瘤包绕动脉且管壁浸润或管腔狭窄。胰周静脉受侵的CEUS诊断标准为肠系膜上静脉、门静脉被肿瘤包绕、狭窄、扭曲或闭塞。结果经手术病理诊断的94例胰腺癌患者,其中胰头癌62例,胰腺体尾部癌32例,超声造影6例(6.4%)表现为实质期不均匀高增强,78例(83%)表现为实质期呈不均匀低增强,10例(10.6%)表现为实质期不均匀等增强。CEUS诊断CA受侵25例(26.6%),未受侵69例(73.4%),其诊断的敏感度、准确性、特异度、阳性预测值、阴性预测值分别为63.6%、79.7%、84.7%、56.0%、88.0%。CEUS诊断肠系膜上动脉(SMA)受侵27例(28.7%),未受侵67例(71.3%),其诊断的敏感度、准确性、特异度、阳性预测值、阴性预测值分别为66.6%、77.6%、80.2%、44.0%、91.0%。CEUS诊断PV受侵27例(28.7%),未受侵67例(71.3%),其诊断敏感度、准确性、特异度、阳性预测值、阴性预测值分别86.6%、94.6%、98.4%、96.2%、94.0%;CEUS诊断SMV受侵26例(27.6%),未受侵68例(72.4%),其诊断敏感度、准确性、特异度、阳性预测值、阴性预测值分别为75.0%、87.2%、92.4%、80.7%、89.7%。结论 CEUS作为一种安全、无创、相对廉价的有效诊断方法,对胰腺恶性肿瘤的诊断及对胰周血管侵犯的评估有较高的临床应用价值,可对能否行外科手术切除作出术前评估,值得临床推广应用。     

胃癌螺旋CT征象与手术病理的相关性研究

目的探讨螺旋CT各种征象(包括病灶厚度、大小、强化特点、浸润深度、淋巴结转移和TNM分期)与手术病理之间的关系。方法本组对57例胃癌行低张水充盈螺旋CT三期增强扫描,并与手术病理对照。结果螺旋CT表现病灶厚度、大小与手术病理的浆膜侵犯、淋巴结转移和TNM分期均相关(P<0.05);螺旋CT的强化特点与手术病理的淋巴结转移相关(P<0.05),与浆膜侵犯及TNM分期不相关。螺旋CT对胃癌浸润深度、淋巴结转移和远处转移的准确性分别为82.46%、78.95%和100%,均与手术病理一致(P<0.05)。结论胃癌螺旋CT征象与手术病理之间具有相关性,可依据其影像表现特点推测出胃癌的病理学特性,从而指导手术及判断预后。     

Pancreatic head cancer: accuracy of CT in determination of resectability

Background Pancreatic cancer is a devastating disease whose early detection remains difficult. There is no 100% reliable imaging test to diagnose and stage pancreatic cancer. We assessed the surgical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival rates of patients who had pancreatic head cancer.Methods Eighty-nine patients who had pancreatic head cancer were investigated with spiral CT. Based on the preoperative CT results, we assigned patients to one of three CT groups based on resectability.Results A correlation between classification of CT resectability and intraoperative finding was found in 83% of patients. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of spiral CT in identifying predictive unresectability were 79%, 82%, 91%, 62%, and 81%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosis of vascular invasion were 94%, 84.2%, 94%, 84%, and 91.3%, respectively.Conclusion The use of CT in the evaluation of pancreatic tumors provides valuable preoperative assessment of surgical resectability and should be performed for clinical examination. Classifying patients by tumor resectability on CT helps to estimate more precisely the tumor stage and to prognosticate survival rates of these patients.     

EpCAM和CD44在胃癌中的表达及临床意义

通过检测上皮细胞粘附分子（epithelial cell adhesion molecule,Ep CAM）、CD44在不同胃组织中的表达差异,探讨其与胃癌发生、浸润和转移的关系。方法采用免疫组化法检测经病理证实的胃腺癌组织标本42例、不典型增生组织标本25例和正常胃组织标本25例中Ep CAM和CD44的表达,分析其表达与临床病理参数间的关系,及Ep CAM和CD44表达的相关性。结果 Ep CAM在胃腺癌组织、不典型增生组织和正常胃组织中的阳性表达率两两比较差异均有统计学意义（88.1%,64.0%,8.0%,P均〈0.01）,在胃腺癌组织中表达与淋巴结转移、浆膜侵润和TNM分期（Ⅰ~Ⅱ/Ⅲ~Ⅳ）有关（P均〈0.05）;CD44在胃腺癌组织中、不典型增生组织和正常胃组织的阳性表达率两两比较亦均有统计学差异（69.4%,40.0%,12.0%,P均〈0.01）,其在胃腺癌组织中表达与胃癌TNM分期、分化程度（中高分化/低分化）和淋巴结转移有关（P〈0.05,P〈0.01）。Ep CAM和CD44在胃腺癌组织中的表达呈正相关（r=0.363,P〈0.01）。结论 Ep CAM和CD44在胃癌的发生、发展中起重要作用,与胃癌的浸润、转移有关,联合检测可作为胃癌早期诊断、判断预后的的指标。     

贲门癌MDCTT分期与病理对照

目的评价MDCT对贲门癌T分期的意义。方法参照AJCC 2010胃癌分期标准,对65例贲门癌患者通过术前MDCT影像行T分期,对CT显示不同层状结构病例,分别分析CT T分期与病理T分期的差异、病变胃壁厚度与T分期的相关性;以手术病理分期为金标准,计算MDCT对贲门癌T分期诊断的敏感度与准确率。结果 CT显示胃壁三层结构32例(32/65,49.23%),二层结构19例(19/65,29.23%),未显示分层14例(14/65,21.54%)。CT显示三层结构、二层结构及未显示分层者的T分期准确率分别为87.50%(28/32),73.68%(14/19),78.57%(11/14)。贲门癌病变胃壁厚8～41mm,平均23.4mm,以20mm为阈值,厚度≥20mm的病变86.67%(39/45)侵犯浆膜。结论 CT显示胃壁层次不同可用于贲门癌的分期诊断;MDCT对贲门癌的术前T分期与病理结果的一致性较好。     

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。     

双重超声造影与增强CT在胃癌T分期中的临床应用研究

目的:本研究旨在探讨联合胃双重超声造影与增强CT技术在胃癌术前T分期中应用的临床价值。方法:选取术前胃镜证实的胃癌患者65例,所有纳入患者均于术前行胃双重超声造影及增强CT检查,选取胃病变组织和周边正常胃壁组织为感兴趣区绘制时间-强度曲线来评价病变区的微循环灌注特征,并与增强CT对照研究,分别对胃癌浸润胃壁深度(T分期)进行评估,并与术后病理分期结果进行对照分析,评价胃癌的微循环灌注特征与病理分期的相关性。结果:双重超声造影对胃癌的判断准确率为89.2%(58/65);胃增强CT扫描胃癌T分期判断的准确率为75.4%(49/65)。胃癌病变组织的增强强度值(EI)大于周围正常胃壁组织,与浸润深度成正相关,双重超声造影在胃癌的判断上较胃增强CT更准确,差异有统计学意义(P<0.05)。结论:双重超声造影可同时获得病灶解剖结构和微循环灌注信息,对胃癌局部浸润深度的判断与病理一致性较高;在胃癌浸润程度的量化分析方面优于增强CT,可作为评估胃癌术前分期和微循环灌注的一种非侵入性、安全、有效、可推广应用的检查方法。     

CT's capability in detecting advanced gastric cancer

Upper GI series and CT scans of 23 patients with advanced gastric cancer were reviewed and correlated to determine CT's capability in detecting gastric tumors. The CT images of the gastric carcinomas revealed either a mass or thickening of the wall. These abnormalities were present in 78% of the cases whereas CT demonstrated a mass in 52%. The most difficult site for CT diagnosis of gastric cancer was the antrum. Diagnostic accuracy of CT in evaluating tumor invasion of adjacent structures is reportedly high. However, in the present study this was not necesarily true. In 4 of 5 patients whose gastric tumors proved unresectable, CT failed to reveal adjacent invasion. This suggests that CT is not always reliable in predicting surgical resectability.     

Detecting recurrence of gastric cancer: the value of FDG PET/CT

Purpose  In order to assess the diagnostic performance of Positron emission tomography/Computed tomography (PET/CT) for detecting recurrence in gastric cancer patients with clinical or radiologic suspicion of recurrence after surgical resection. Materials and methods  Over a 4-year period, 105 post-operative patients with gastric cancer, who underwent PET/CT due to clinical or radiologic suspicion of recurrence during follow-up, were collected after confirming their PET/CT findings. The number and site of positive FDG uptake were retrospectively analyzed, and were correlated with the final diagnosis, by calculating the diagnostic values and assessing the causes of misdiagnosis. Results  Of all 105 patients, 75 patients were confirmed to have true recurrence with 108 recurrence sites. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for diagnosing true recurrence on a per-person basis were 75%, 77%, 89%, 55%, and 75%, respectively. On a per-lesion basis, 75 (69%) of 108 true recurrences showed positive FDG uptake, while 75 (89%) of 84 positive FDG uptake was confirmed to have true recurrence. Conclusion  PET/CT was relatively accurate in detecting recurrence in post-operative patients with gastric cancer. Moreover, PET/CT might be helpful in confirming the presence of recurrence particularly in patients who were highly suspicious of recurrence, because of its high positive predictability.     

Scope and limitations of diagnostics in breast disease--focussing on large core biopsy

Percutaneous high speed large core biopsy (LCB) using a 14-gauge-needle, supported by sonographic procedures, is a safe and reliable method for the diagnosis of benign and malignant breast lesions in daily practice. All malignant diagnoses (B5)--comprising 44 % (267/604) of cases--were confirmed by subsequent surgical biopsy. This indicates a positive predictive value of 100 %. Evidence for uncertain dignity in LCB (categories B3 and B4) was found in 3 % of our cases (20/604), requiring open breast surgery for further clarification. This is strongly supported by the fact that 22 % of B3 and 82 % of B4 cases were identified as carcinomas in subsequent surgery. In 9 % of our cases (53/604), histology was only questionably representative (category B1) without cancer in the follow-up. In the B2-category--which comprised nearly 44 % of all cases (n = 263)--the positive predictive value ranged at 2 %. For clinical investigation, mammography, breast ultrasound and LCB the sensitivity were at 79 %, 92 %, 92 % and 98 %, respectively. The specificity of clinical findings, mammography, breast ultrasound and LCB ranged at 88 %, 67 %, 79 % and 99 %, respectively. The combination of the 3 methods: clinical findings, mammography and breast ultrasound (leading to a "total diagnostic score" provided a sensitivity and specificity of 97 % and 52 %. LCB revealed an excellent specificity of 99 %. Therefore, large core biopsy takes up a definite and reliable place in procedures of breast diagnostics, thereby preventing a high number of unnecessary open surgical interventions.