多排螺旋CT双期扫描三维重建技术胃癌评估

Abstract Objective： To evaluate the diagnostic value of two-phase multidetector-row spiral CT threedimensional reconstruction technique in TNM staging of gastric cancer. Methods： In 29 patients with gastric carcinoma pathologically conformed, plan scans were done firstly. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of anisodamine and effervescent granules. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase, and the source images were thin reconstructed. The stomach to three-dimension analysis was constructed by volume rendering （VR） multiplanaz volume reconstruction （MPVR）, shaded surface display （SSD） and CT virtual gastroscopy （CTVG） technique. In combination with the sources images, gastric tumour invasion and lymph node metastasis was assessed, and TNM staging was performed. Results： In 29 cases of gastric carcinoma, the sensitivity and specificity of two-phase multidetector-row spiral CT three-dimensional reconstruction technique in T1, T2, T3 and Ta staging, the sensitivity and specificity was 50% and 50%, 87.5% and 77.8%, 83.3% and 76.9% and 100% and 80% respectively. For the N staging, the sensitivity and specificity in No, N1, and N2 N3 was 83.3% and 71.4%, 87.5% and 77.8% and 81.8% and 75% respectively. The sensitivity and the specificity for M1 staging was 100%. Conclusion： The reconstruction technique in combination with 16-slices spiral-CT can perform TNM staging well and effectively guide the choice of the surgical procedures for gastric cancer.     

64排螺旋CT三期增强扫描判断胃癌淋巴结转移的临床价值

探讨64排螺旋CT三期增强扫描判断胃癌淋巴结转移的指标参数及临床应用价值。方法:确诊为胃癌的患者,术前利用64排螺旋CT三期增强扫描检出胃周围淋巴结,与术后病理结果对照,从淋巴结短径、淋巴结CT值、淋巴结短长径比值、门静脉期与平扫期CT值之差等参数分析确定对判断淋巴结转移有价值的指标。结果:淋巴结门脉期CT值≥65 Hu、淋巴结短径≥6 mm、淋巴结短长径比≥0.6、淋巴结门静脉期与平扫期CT值差≥35 Hu,以上4项中有两项符合要求判断淋巴结转移,敏感性为93.1%,特异性为50%,有三项符合要求判断淋巴结转移,敏感性为73.5%,特异性为75%。结论:64排螺旋CT三期增强扫描综合应用淋巴结的各项指标参数,可以对胃癌胃周围淋巴结是否转移作出比较可靠的判断,为术前制定合理的个性化治疗策略提供参考。      

多层螺旋CT三维重建对胃癌术前分期的价值

目的:通过对胃癌患者实施多层螺旋CT（multi-slice spiral computed tomography,MSCT）及三维重建后进行术前分期,评价其准确性及对胃癌治疗方式选择的价值。方法:2010年8月-2011年10月在中国医科大学附属盛京医院胃肠、营养外科住院,并经术前胃镜及病理检查确诊的胃癌患者64例。全部患者在术前一周内进行64层螺旋CT平扫及双期增强扫描,将获得的扫描影像数据以1.0 mm薄层重建后传至后期工作站。由2名从事腹部CT工作5年以上的高年资影像科医生应用工作站软件对图像作多平面重建（multi-planar reformations,MpR)。再由1名从事腹部CT工作5年以上的高年资影像科医生和1名高年资胃肠外科医生在不明了胃镜结果的情况下在PACS上通过协商读片,分别分析MSCT横断位及MpR图像。对照手术后的病理结果,计算MSCT横断位和MpR图像对胃癌的检出率和T、N分期的准确性;比较MSCT横断位和MpR图像对胃癌T、N分期准确性。结果:对原发胃癌病灶的检出率,MSCT横断图像和MpR图像分别是90.63%(58/64)和95.31%(61/64)。与组织病理学分期比较,依据MpR图像的T分期准确率为85.25%(52/61),高于依据MSCT横断位图像的65.57%(40/61)(P=0.012);而MpR图像的N分期准确率为73.77%(45/61),与MSCT横断位图像的67.21%(41/61)比较,其差异无统计学意义(P=0.427)。结论:MSCT横断位结合MpR图像能更清晰显示肿瘤形态、大小以及与邻近结构的关系,能较为全面和准确地观察胃癌淋巴结的位置、大小及数量,更好地进行术前分期,有助于胃癌治疗方式的选择。     

64排螺旋CT三期增强扫描在判断胃癌浸润深度的临床价值

目的:探讨64排螺旋CT三期增强扫描在术前判断胃癌浸润深度的临床价值。方法:确诊为胃癌的65例患者,术前均通过64排螺旋CT三期增强扫描判断胃癌浸润的深度,与术中探查及术后病理结果进行对比。结果:65例胃癌患者术前行64排螺旋CT三期增强扫描,通过与术中探查及术后病理对比,对胃癌T分期总的准确率为84.62%（55/65）,T1期为83.33%（5/6）,T2-3期为89.47%（34/38）,T4a期为75%（12/16）,T4b期为80%（4/5）。 结论:64排螺旋CT三期增强扫描在术前判断胃癌浸润深度的准确度高,为判断能否手术切除提供可靠的依据。     

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.     

16层螺旋CT双期扫描在胃腺癌浸润中的价值

 目的　评价 16层螺旋CT双期动态增强扫描在胃腺癌浸润中的诊断价值。方法　 37例胃腺癌患者 ,术前采用 16层螺旋CT进行平扫和动脉期、静脉期双期增强扫描 ,采用仿真内镜技术 (CTVG) ,多层面容积重建法 (MPVR)和最大密度投影 (MIP)技术进行重建分析 ,与术后病理相对照。结果　大多数胃腺癌患者CT扫描发现动脉期轻度或中度强化 ,静脉期强化一般更明显。发现静脉期的强化平均范围要大于动脉期 ,T分期较高 ,结果与手术病理一致。结论　 16层螺旋CT扫描结合重建有助于胃腺癌的准确T分期     

多层螺旋CT血管造影三维重建技术在肝癌诊断中的应用

目的探讨多层螺旋CT血管造影三维重建技术在肝癌诊断中的应用价值。方法选择拟诊为肝癌患者81例作为研究对象,所有患者给予多层螺旋CT血管造影三维重建,记录造影参数,判断诊断价值。结果在81例患者中,病理诊断为肝癌67例,肝硬化14例,肝癌患者的BF值显著高于肝硬化患者,BV、TTS与TTP值显著低于肝硬化(P<0.05)。CT三维重建图像均可清晰所有患者的肝动脉,MIP、DSA、MPR/CPR重建方法显示肝血管有高度一致性,重建评分对比差异无统计学意义(P>0.05)。多层螺旋CT血管造影三维重建诊断肝癌的敏感性、特异性与准确性分别为95.5%、81.3%和95.1%。结论多层螺旋CT血管造影三维重建技术在肝癌诊断中的应用具有很高的诊断敏感性、特异性与准确性,可反映肝脏血流的灌注状况,可清晰肝脏血管结构。     

16排螺旋CT诊断胃癌淋巴结转移的可行性

目的:探讨16排螺旋CT诊断胃癌淋巴结转移的可行性与价值。方法:选取2011年7月至2014年7月在我院进行诊治的胃癌患者78例,16排螺旋CT进行诊断,并进行常规CT扫描与增强CT灌注扫描。结果:78例患者中有淋巴结转移60例,无淋巴结转移18例,淋巴结转移发生率为76.9%。无转移淋巴结组的肿瘤直径为（0.54±0.11）cm,而有淋巴结转移组的肿瘤直径为（0.87±0.12）cm,对比差异有统计学意义(P＜0.05)。所有患者都顺利完成CT扫描,图像无伪影,靶平面保持良好。有淋巴结转移组的PS与BV值都明显高于无淋巴结转移组(P＜0.05)。经过CT判定为淋巴结转移61例,无淋巴结转移17例,与手术病理判定对比,螺旋CT诊断胃癌淋巴结转移的敏感性与特异性分别为100.0%和94.4%。结论:16排螺旋CT诊断胃癌淋巴结转移能获得更好的肿瘤血液动力学信息,具有很好的诊断敏感性与特异性,对胃癌制定合理治疗方案及判断预后有重要的临床意义。     

螺旋CT扫描对进展期胃癌浸润深度的研究

目的 探讨螺旋CT扫描对判定进展期胃癌浸润深度的价值。方法 搜集福建中医药大学附属人民医院CT影像资料完整,并经病理证实为进展性胃癌的病人63例,分析CT扫描判定胃癌T分期中各期与术后病理分期的符合率。结果 CT术前T分期的准确率为77.78%。CT—T₁分期的准确率为40%,CT—T₂分期的准确率为83.33%,CT—T₃分期的准确率为76%,CT—T₄分期的准确率为88%。结论 螺旋CT扫描对胃癌的局部浸润深度判断准确,有助于胃癌的术前分期,能指导临床治疗方案的选择。     

螺旋CT扫描多平面重建与结直肠癌

[目的]探讨结、直肠癌疗前经多平面重建(MPR，Multiplanar Reconstruction)螺旋CT扫描检查的临床价值。[方法]对43例经手术病理证实的结、直肠癌的术前CT表现和手术病理进行比较，重点分析肿瘤的CT征象、肠外侵犯程度的判断及肿瘤分期。[结果]多平面重建螺旋CT诊断符合率达74．42％。[结论]多平面重建螺旋CT扫描对结、直肠癌外侵的判断和肿瘤分期有重要的意义。     

MSCT支气管动脉三维成像对中心型肺癌的血供研究及其临床意义(英文)

目的探讨多层螺旋 CT(MSCT)三维支气管动脉成像在中心型肺癌中的影像学表现及应用价值,为中心型肺癌的血供来源和介入治疗提供理论依据。方法对18例中心型肺癌的病人行 MSCT 造影增强检查,采用实时螺旋薄层 CT 扫描,在独立工作站行支气管动脉三维重建,使用不同的旋转轴观察支气管动脉的空间解剖细节。结果其中6例(33.33%)中心型肺癌的支气管动脉三维图像能够清晰显示出去支气管动脉的起源、走行的路径(肺内段和纵隔段)和血管直径等情况。有肺动脉明显狭窄截断的病例支气管动脉显示率最高,且明显增粗,表明此类肺癌的血供来源主要以支气管动脉为主。三维成像中以容积显示技术(SVR 像)显示最佳。结论 MSCT 三维支气管动脉成像能够准确、直观地显示支气管动脉的空间解剖特点,为中心型肺癌的血供研究与介入治疗提供理论基础。     

MSCT支气管动脉三维成像对中心型肺癌的血供研究及其临床意义

目的探讨多层螺旋CT(MSCT)三维支气管动脉成像在中心型肺癌中的影像学表现及应用价值,为中心型肺癌的血供来源和介入治疗提供理论依据。方法对18例中心型肺癌的病人行MSCT造影增强检查,采用实时螺旋薄层CT扫描,在独立工作站行支气管动脉三维重建,使用不同的旋转轴观察支气管动脉的空间解剖细节。结果其中6例(33．33％)中心型肺癌的支气管动脉三维图像能够清晰显示出去支气管动脉的起源、走行的路径(肺内段和纵隔段)和血管直径等情况。有肺动脉明显狭窄截断的病例支气管动脉显示率最高,且明显增粗,表明此类肺癌的血供来源主要以支气管动脉为主。兰维成像中以容积显示技术(SVR像)显示最佳。结论MSCT三维支气管动脉成像能够准确、直观地显示支气管动脉的空间解剖特点,为中心型肺癌的血供研究与介入治疗提供理论基础。     

Application Value of Multi-Slice Spiral CT Multiplanar Reconstruction Technique in the Diagnosis and Clinicopathological Analysis of Gastrointestinal Lymphoma

Objective: The purpose was to explore the value of multi-slice spiral CT (MSCT) multiplanar reconstruction technique in the diagnosis and clinicopathological analysis of gastrointestinal lymphoma (GIL). Methods: 82 GIL patients treated in our hospital from February 2018 to February 2019 were selected as the experimental group of this study, and 82 patients with other gastrointestinal tumors diagnosed by pathology during the same period were selected as the control group. Both groups of patients were scanned by MSCT and analyzed by multiplanar reconstruction technique to compare the diagnostic results and clinicopathological indexes of the two groups. Results: The diagnostic accuracy of MSCT multiplanar reconstruction scanning was higher, with no statistical difference from that of pathological examination results (P > 0.05). Compared with the control group, the objective image noise of the experimental group was lower while the signal-to-noise ratio (SNR) was higher, with significant differences between the two groups (P < 0.05). There were statistically significant differences in the CT reconstruction parameters of different tumor types and different clinical stages in the experimental group (P < 0.05). Conclusion: MSCT multiplanar reconstruction technique is effective in diagnosing GIL, and the CT reconstruction parameters have important guiding value for the differentiation of tumor tissue types and clinical stages. The technique enables the doctors to fully grasp the clinical manifestations of the disease and select appropriate therapeutic regimens, improving the diagnostic accuracy and prognostic effect of the disease, which is worthy of wide application and promotion in clinic.     

Virtual Non-Contrast Computer Tomography (CT) with Spectral CT as an Alternative to Conventional Unenhanced CT in the Assessment of Gastric Cancer

Objective: The purpose of this study was to evaluate computed tomography (CT) virtual non-contrast (VNC)spectral imaging for gastric carcinoma. Materials and Methods: Fifty-two patients with histologically provengastric carcinomas underwent gemstone spectral imaging (GSI) including non-contrast and contrast-enhancedhepatic arterial, portal venous, and equilibrium phase acquisitions prior to surgery. VNC arterial phase (VNCa),VNC venous phase (VNCv), and VNC equilibrium phase (VNCe) images were obtained by subtracting iodinefrom iodine/water images. Images were analyzed with respect to image quality, gastric carcinoma-intragastricwater contrast-to-noise ratio (CNR), gastric carcinoma-perigastric fat CNR, serosal invasion, and enlargedlymph nodes around the lesions. Results: Carcinoma-water CNR values were significantly higher in VNCa,VNCv, and VNCe images than in normal CT images (2.72, 2.60, 2.61, respectively, vs 2.35, p≤0.008). Carcinomaperigastricfat CNR values were significantly lower in VNCa, VNCv, and VNCe images than in normal CTimages (7.63, 7.49, 7.32, respectively, vs 8.48, p< 0.001). There were no significant differences of carcinoma-waterCNR and carcinoma-perigastric fat CNR among VNCa, VNCv, and VNCe images. There was no difference inthe determination of invasion or enlarged lymph nodes between normal CT and VNCa images. Conclusions:VNC arterial phase images may be a surrogate for conventional non-contrast CT images in gastric carcinomaevaluation.     

128层螺旋CT对胃癌可切除状况的评估价值

目的探讨128层螺旋CT对胃癌可切除状况的评估价值。方法选择诊治的胃癌患者120例作为研究对象,所有患者都给予128层螺旋CT检查,评估胃癌可切除性并记录影像学特征。结果在120例患者中,螺旋CT诊断为Ⅰ期66例、Ⅱ期24例、Ⅲ期18例、Ⅳ期12例,与病理分期有较好的一致性,临床分期诊断准确率为95.0%。CT评价胃癌可切除68例,实际采用手术切除治疗65例,CT对胃癌可切除状况的评估敏感性、特异性分别为98.5%和98.1%。全胃切除35例,胃部分切除30例,都顺利完成手术,围手术期无严重并发症发生。结论128层螺旋CT在胃癌中的应用可准确判断临床分期,具有很好的影像学特征,有利于指导与评估手术切除治疗。     

螺旋CT对进展期胃癌诊断的临床价值

目的评价螺旋CT对进展期胃癌诊断的临床价值。方法对45例经胃镜活检证实的胃癌患者术前行螺旋CT检查，并与术后病理检查结果对照分析。结果45例进展期胃癌，病灶检出率为100％，TNM术前分期准确率达82．2％（37／45）。结论螺旋CT对进展期胃癌诊断及术前分期的准确性高，对指导手术方式和判断预后具有重要意义。