多层螺旋CT多平面重建对径线较小的食管癌淋巴结转移的诊断价值

目的探讨多层螺旋cT多平面重建（multi—planarreconstruction,MPR）对食管癌短径〈8mm的转移淋巴结术前诊断的意义。方法回顾分析经手术病理证实的104例食管癌淋巴结术前多层螺旋cT多平面重建的影像特征。结果对食管癌短径〈8mln的淋巴结,以“长径≤11．1mm”为诊断标准时,敏感度及特异度分别为90．8％、36．3％;以“横纵比≥Q65”为诊断标准时,敏感度及特异度分别为77．6％、80．1％;以“强化程度（淋巴结cT值／同层肌肉CT值）≥n95”为诊断标准时,敏感度及特异度分别为30．3％、73．3％;以“淋巴结边缘有无模糊”为诊断转移的标准时,敏感度和特异度分别为7．9％和75．5％。结论食管癌短径〈8min的淋巴结中仍然存在很多转移淋巴结,采用“横纵比≥0．65”作为二次判断淋巴结转移的诊断标准,并辅助以长径、边缘有无模糊综合判断,有助于提高cT诊断淋巴结转移的准确率。     

螺旋CT增强扫描对胃癌淋巴结多发转移的诊断价值

目的探讨螺旋CT增强扫描在胃癌淋巴结多发转移中的影像特征和诊断价值。方法选取2014年6月至2016年6月间辽宁省朝阳市中心医院收治的50例胃癌患者,采用多排螺旋CT(MSCT)平扫后再行增强双期扫描,以术前CT检查和病理结果作为对照,进行对比分析。结果多层螺旋CT增强扫描诊断胃癌淋巴结转移的特异度为90.0%,敏感度为68.0%,多层螺旋CT诊断符合率为86.0%。多层螺旋CT平扫和增强扫描诊断结果相同者26例,其中CT平扫漏诊10例,误诊4例。多层螺旋CT增强扫描淋巴结转移符合率高于多层螺旋CT平扫,差异有统计学意义(P<0.05)。结论增强扫描和CT平扫组合能够清晰显示胃癌转移淋巴结形态、大小,提高检出胃癌类型和阶段的诊断率,值得推广。     

CT在妇科恶性肿瘤淋巴结转移中的诊断价值

目的探讨CT在妇科恶性肿瘤淋巴结转移中的诊断价值.方法对322例妇科恶性肿瘤初治患者进行全腹螺旋CT扫描,以CT影像上淋巴结清晰且最短径≥10mm或有中心性坏死视为淋巴结CT诊断阳性,并与手术后的病理诊断结果进行比较.结果322例患者中,CT报告显示盆腹腔淋巴结阳性66例;术后病理检查盆腹腔淋巴结转移34例;CT诊断淋巴结转移的敏感度为58.8%,特异度为84.0%;阳性预测值30.3%,阴性预测值为94.5%;Youden指数为0.43.结论螺旋CT检查对诊断妇科恶性肿瘤的盆腔淋巴结转移的特异度较高,可以为早期的子宫内膜癌及卵巢癌的淋巴结清扫范围提供参考.     

纵隔镜与CT评估非小细胞肺癌术前纵隔淋巴结状态的前瞻性研究

目的 比较CT与纵隔镜评估非细胞肺癌(NSCLC)术前纵隔淋巴结状态的价值.方法 152例Ⅰ～Ⅲ期NSCLC患者术前均接受CT和纵隔镜检查.以病理结果为参照,分别计算CT与纵隔镜评估NSCLC术前纵隔淋巴结状态的敏感度、特异度、阳性预测值、阴性预测值和准确度.采用Pearsonχ2检验比较CT与纵隔镜的准确度,采用ROC诊断曲线比较CT与纵隔镜诊断效果.结果 CT诊断NSCLC纵隔淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为73.8%、70.1%、64.9%、78.2%和71.7%,纵隔镜分别为83.1%、100.0%、100.0%、88.8%和92.8%,纵隔镜检查的准确度和诊断效果优于CT(P<0.001).纵隔镜检查的并发症发生率为4.6%,假阴性的发生率为7.2%.结论 CT单独评估NSCLC术前纵隔淋巴结状态的准确度不足,纵隔镜是评估NSCLC术前纵隔淋巴结状态准确和安全的方法.     

食管癌转移淋巴结多层螺旋CT诊断标准探讨

目的：通过多层螺旋CT薄层多平面重建图像所见与病理结果对照，探讨转移淋巴结的诊断标准。方法以病理诊断为金标准，回顾性分析208例胸段食管癌患者淋巴结的术前多层螺旋CT多平面重建图像，测量淋巴结的长径、短径，计算出直径比（短径/长径，将淋巴结直径比≥0.7视为圆形淋巴结），同时观察淋巴结有无环形强化、成簇分布、边缘模糊等影像学特征，分析比较各项指标的诊断价值。结果以短径≥1.0 cm作为转移淋巴结的诊断标准，敏感度为23.6%，特异度为98.6%，约登指数为0.22。以短径≥0.8 cm作为转移淋巴结诊断标准，对于短径＜0.8 cm的淋巴结运用直径比≥0.7作为诊断转移的标准，诊断效能有了明显的提高，敏感度为83.8%，特异度为82.9%，约登指数为0.67。以淋巴结有“环形强化”或“边缘模糊”征象作为诊断标准的阳性预测值分别为62.2%、89.4%。结论用较小的短径作为转移淋巴结的诊断标准，能提高诊断效能；直径比有助于提高CT术前诊断转移淋巴结的价值；边缘模糊、环形强化可作为诊断转移淋巴结的参考标准。     

18FDG PET/CT对非小细胞肺癌N2期淋巴结诊断的价值

目的:通过对18FDG PET/CT、CT对非小细胞肺癌N2期纵隔淋巴结的诊断与术后病理结果比较,探讨18FDG PET/CT对N2期淋巴结的诊断价值。方法:72例原发NSCLC患者共切除纵隔N2期淋巴结280枚,回顾性分析术前CT及18FDG PET/CT检查对纵隔N2期淋巴结的诊断结果,并与病理结果分别进行对比分析。结果:175枚N2期淋巴结CT诊断阳性,其诊断的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为:74.0%、50%、62.5%、61.7%及63.8%;而172枚N2期淋巴结18FDG PET/CT诊断阳性,其诊断的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为:89.0%、68.7%、79.3%、75.6%及85.2%,均明显优于CT（P＜0.05）。而105例短径<10 mm的纵隔淋巴结中,36.2%（38/105）为转移淋巴结,18FDG PET/CT对CT诊断阴性的纵隔淋巴结的诊断敏感度、特异度、准确度、阳性及阴性预测值分别为:86.8%、88.1%、87.6%、80.5%及92.2%;其中高代谢的N2期小淋巴结主要分布于2R、4R/L、7组:36.4%（12/33）、27.3%（9/33）、36.4%（12/33）。结论:18FDG PET/CT对肺癌N2期纵隔淋巴结的诊断价值明显优于CT,尤其对于纵隔内短径<10 mm淋巴结转移的诊断具有明显优势。     

纵隔镜检查术在PET/CT纵隔淋巴结阳性的非小细胞肺癌中的应用北大核心CSCD

目的探讨纵隔镜检查术在纵隔或肺门淋巴结PET/CT(positron emission tomography-computed tomography)代谢阳性的非小细胞肺癌中(non-small cell lung cancer,NSCLC)的应用价值。方法回顾性分析纵隔镜检查术前PET/CT纵隔或肺门淋巴结异常的NSCLC病例,以病理结果为标准,计算纵隔镜检查术诊断纵隔淋巴结转移的敏感度、特异性、阳性预测值、阴性预测值和准确率以及PET/CT的假阳性率。结果 2007年4月—2011年12月期间,73例患者符合条件。纵隔镜检查术诊断纵隔淋巴结转移的敏感度、特异性、阳性预测值、阴性预测值和准确率分别为91.3%、100%、100%、87.1%和94.5%。PET/CT诊断纵隔淋巴结转移的假阳性率高达30.8%。如果将非巨块型纵隔淋巴结代谢升高且双侧肺门淋巴结代谢升高定义为纵隔淋巴结阴性,其阳性预测值升高至81.1%。结论在PET/CT纵隔或者肺门淋巴结代谢升高的NSCLC,纵隔镜检查术诊断纵隔淋巴结转移的敏感度和特异性高。对PET/CT代谢阳性的纵隔淋巴结需要病理确认,特别是合并双侧肺门对侧性代谢增高的纵隔淋巴结。     

MSCT三期扫描在直肠癌术前TNM 分期诊断价值

目的:评价16层螺旋CT平扫及三期增强扫描对直肠癌术前诊断及TNM分期的诊断价值。方法:回顾性分析75例经病理证实的直肠癌,男性43例,女性32例,平均年龄57岁。所有患者术前采用16层螺旋CT平扫及三期增强扫描,所得数据行薄层及三维重组,对直肠肿瘤进行术前TNM分期,并与病理结果进行对照分析。结果:16层螺旋CT对直肠癌T 分期判定的准确率为83% ,对直肠癌N 分期判定的准确率为76% ,16层螺旋CT判断淋巴结转移的敏感性、特异性、阳性预测值及阴性预测值分别为62% 、87% 、73% 、80% 。16层螺旋CT判断肿瘤浆膜面浸润的敏感性、特异性、阳性预测值及阴性预测值分别为85% 、55% 、84% 、58%。结论:16层螺旋CT平扫及三期增强扫描对直肠癌的术前TNM分期与病理分期有较好的一致性,具有重要的临床价值。      

术前CT检查在可手术非小细胞肺癌TNM分期中的应用评价

目的比较术前CT检查和术后病理诊断的非小细胞肺癌TNM分期结果,评价术前CT检查对非小细胞肺癌TNM分期的临床参考价值。方法112例临床确诊为NSCLC的患者行术前螺旋CT检查,临床分期为Ⅰ～ⅢA患者行手术切除加系统性淋巴结清扫,术前CT检查对TNM的分期结果定义为临床TNM（cTNM）,术后的病理分期定义为病理TNM（pTNM）。对比患者的cTNM与pTNM,评价术前CT检查确定非小细胞肺癌TNM分期的敏感度、特异性和准确率。结果（1）术前CT检查诊断T分期的敏感度和特异性分别为76.6％和85.7％,阳性预测值为92.2％,阴性预测值为62.5％,准确率为79.5％。一致性检验有统计学意义（Kappa=0.658,P<0.05）;（2）术前CT检查诊断纵隔淋巴结转移的敏感度和特异性分别为72.9％和84.9％,阳性预测值为84.3％,阴性预测值为73.8％,准确率为78.6％,一致性检验有统计学意义（Kappa=0.667,P<0.05）。螺旋CT检查诊断 4R、5、6 组纵隔淋巴结转移的准确率和特异性偏低,其中4R组淋巴结转移的假阳性和假阴性较高。结论术前CT检查对非小细胞肺癌TNM分期有重要的临床参考价值,但存在假阳性和假阴性,应结合其他检查手段如PET-CT或纵隔镜等提高术前TNM分期准确率。     

非小细胞肺癌纵隔淋巴结分期:螺旋CT和病理检查对照

背景与目的:非小细胞肺癌纵隔淋巴结分期对肿瘤的规范化治疗方案的选择和预后判断具有极其重要的意义。本研究旨在通过比较螺旋CT和病理检查对非小细胞肺癌纵隔淋巴结分期的结果,评价螺旋CT检查对纵隔淋巴结分期的临床参考价值。方法:对89例病理确诊的非小细胞肺癌患者同时进行螺旋CT检查和纵隔镜检查,将CT对纵隔淋巴结分期结果与淋巴结最后病理分期做一一对照,对比分析螺旋CT检查诊断纵隔淋巴结转移的敏感性、特异性和准确率。结果:与纵隔淋巴结最后病理分期一一对照,螺旋CT检查诊断纵隔淋巴结转移的敏感性为58.9%,特异性为70.0%,阳性预测值60.5%,阴性预测值68.6%,总的准确率为65.2%。螺旋CT检查诊断4R、5、6、7组淋巴结转移的准确率和特异性偏低,诊断4R组和7组淋巴结转移的假阳性和假阴性较高。结论:螺旋CT检查对非小细胞肺癌纵隔淋巴结临床分期有一定的临床参考价值,但存在一定的假阳性和假阴性,应结合其他检查手段,比如纵隔镜,以进行更精确的分期。     

Clinical value of multidetector row computed tomography in detecting lymph node metastasis of early gastric cancer.

AIMS: To evaluate the clinical value of multidetector row computed tomography (MDCT) as a pre-operative staging tool for lymph node metastasis in patients with early gastric cancer (EGC). METHODS: In 278 consecutive patients with EGC, lymph node metastasis was evaluated pre-operatively with MDCT at a slice thickness of 2.5mm (n=57), 5.0mm (n=188), or 7.5mm (n=33). RESULTS: Overall accuracy of nodal category from N0 to N3 was 86% for MDCT and 95% for operative assessment. Regarding accuracy in detecting at least one metastatic lymph node, area under curves (AUC) of receiver operating characteristics for 2.5, 5.0, and 7.5-mm slices and assessment during surgery were 0.87, 0.67 and 0.47, and 0.70, which were significantly different (P<0.0001). MDCT image with 2.5-mm could discriminate the presence of lymph node metastasis with diagnostic accuracy: sensitivity 80%; specificity 92%; positive predictive value (PPV) 50%; negative predictive value (NPV) 98%, whereas assessment during surgery was as follows: sensitivity 65%; specificity 98%; PPV 72%; and NPV 97%. CONCLUSIONS: These results suggest that pre-operative assessment with MDCT using thinner slices may detect at least one lymph node metastasis as accurately as assessment during surgery for patients with EGC.     

Gastric carcinoma invading muscularis propria and macroscopic appearance.

From 1965 to 1983, 1362 patients with primary gastric cancer and no other evidence of a malignancy underwent gastric resection in the Second Department of Surgery, Kyushu University. Of these, 117 patients (8.6%) with gastric cancer invading the muscularis propria (pm) were studied clinicopathologically with special reference to the macroscopic appearance: Borrmann type cancer or advanced gastric cancer simulating early gastric cancer (AGC simulating EGC). The Borrmann type cancer comprised 62.4% (73/117) of cases and the AGC simulating EGC comprised 37.6% (44/117). The survival rate for patients with the Borrmann type cancer was lower than in cases of AGC simulating EGC (P less than 0.01). The 10-year survival rate was 82.6% for patients with AGC simulating EGC and 60.5% for those with Borrmann type cancer. A multivariate analysis showed that operative curability and lymph node metastasis are significant prognostic factors and these events differed between the Borrmann type cancer and AGC simulating EGC and the survival rate for patients with the Borrmann type cancer was less favorable. Our findings show that the lymph node dissection is important for the operative curability of pm gastric cancer with the Borrmann type. Postoperative chemotherapy is required in cases of a non-curative resection.     

Application of minimally invasive treatment for early gastric cancer

BACKGROUND AND OBJECTIVES: Although various types of minimally invasive treatment have emerged as the best front-line therapies for early gastric cancer (EGC), there have been no established indications that these attempts are applicable. The purpose of this study was to propose indications for the application of minimally invasive therapy for EGC. METHODS: A total of 566 patients with EGC who had undergone gastrectomy with D2 or more extended lymphadenectomy, from July 1993 to December 1997 were retrospectively analyzed. The risk factors that determine lymph node metastasis were investigated by univariate and multivariate analysis. RESULTS: The rate of lymph node metastasis was 11.8% for all EGC, 3.4% for mucosal cancer, and 21.0% for submucosal cancer. Lymph node metastasis was associated with submucosal invasion, larger tumor size, undifferentiated histology, and the presence of lymphatic or blood vessel invasion (LBVI) by univariate and multivariate analyses. When LBVI was absent, there was no lymph node metastasis if the tumor was smaller than 2.5 cm with differentiated histology, and smaller than 1.5 cm with undifferentiated histology, regardless of depth of invasion. Extra-perigastric lymph node metastases were noted in patients with submucosal tumors that have LBVI while none of mucosal cancer showed extra-perigastric lymph node metastases. CONCLUSIONS: Minimally invasive treatment can be possibly applied for patients with EGC using these four independent risk factors for lymph node metastasis in EGC. For mucosal cancers, EMR is indicated for EGCs without lymph node involvement based on tumor size and histology. When we found LBVI by pathologic examination after EMR, gastrectomy with D1 lymph node dissection is mandatory. For submucosal cancers, patients with small tumors could be treated with laparoscopic wedge resection without lymph node dissection. However, patients with larger sized tumors or tumors with LBVI should be treated with extended (D2) lymph node dissection.     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

Expression of stromal cell-derived factor-1α is an independent risk factor for lymph node metastasis in early gastric cancer

Lymph node metastasis is considered to be a significant prognostic factor for early gastric cancer (EGC). However, no real consensus exists on which patient and/or tumor characteristics are associated with lymph node metastasis. We investigated whether stromal cell-derived factor (SDF)-1α expression correlates with lymph node metastasis in patients with EGC by immunohistochemically examining the expression of SDF-1α in 138 archival tissue specimens of EGC. Of these specimens, 59 (42.8%) and 79 (57.2%) were grouped into SDF-1α-positive and SDF-1α-negative groups, respectively. No significant differences existed with respect to age, gender, tumor location, proportion of tumors >20 mm in size, macroscopic type, depth of invasion or histology between the SDF-1α-positive and -negative groups. However, the SDF-1α-positive group was significantly correlated with lymphovascular invasion and lymph node metastasis. Results of the univariate analyses indicated that lymphovascular invasion, undifferentiated histology and SDF-1α positivity were statistically significant risk factors affecting lymph node metastasis in patients with EGC. Multivariate analyses showed that lymphovascular invasion [hazard ratio (HR), 8.595; 95% confidence interval (CI), 1.694-43.595; P=0.009], undifferentiated histology (HR, 2.965; 95% CI, 1.037-8.471; P=0.043) and SDF-1α positivity (HR, 2.108; 95% CI, 1.316-10.135; P=0.013) were independent risk factors predicting lymph node metastasis in EGC. In conclusion, these results suggest that SDF-1α expression in tumor cells is a predictive marker of lymph node metastasis in EGC.     

Identifying multiple swollen lymph nodes on preoperative computed tomography is associated with poor prognosis along with pathological extensive nodal metastasis in locally advanced gastric cancer

BackgroundAdvanced gastric cancer with extensive lymph node (LN) metastasis is associated with poor outcomes even after R0 gastrectomy. Although multi-detector row computed tomography (MDCT) is the basis of preoperative LN staging, the diagnostic accuracy of pathologically extensive LN metastasis detection by MDCT remains unsatisfactory.MethodsWe retrospectively evaluated diagnostic accuracy for pN2/3 disease by size and number of depicted LNs on MDCT in a single-center cohort of 421 patients with pT2-4 gastric carcinoma. The positive predictive value (PPV) was determined based on the number and short-axis diameter (SAD) of identified LNs, and oncological outcomes were also evaluated according to clinical LN status and pN categories.ResultsThe PPV for detecting pN2/3 disease rose with the SAD value cut-off for one LN, reaching 84.6% at 10 mm with no further increase at 15 mm. However, the SAD cut-off value plateaued at 8 mm (91.3%) when at least two measurable LNs were identified on MDCT. Patients with two measurable LNs with SAD≥8 mm had significantly poorer 5-year overall and recurrence-free survival than patients with fewer than two measurable LNs in the pN2-3 disease. On multivariate analysis, two measurable LNs with SAD≥8 mm was an independent prognostic factor for overall and relapse-free survivals.ConclusionLocally advanced gastric cancer with two measurable LNs with SAD≥8 mm on preoperative MDCT is highly associated with pN2/3 disease and poorer outcomes with upfront surgery. This criterion might be a reasonable indicator for identifying candidates for neoadjuvant treatment of advanced gastric cancer.     

Effect of Demographic and Clinicopathologic Factors on Prognosis of Early Gastric Cancer in Iran

Background: The aim of this study was to estimate some prognostic factors that affect on overall survival ofpatients with early gastric cancer. Methods: A retrospective study had been done on patients diagnosed withearly gastric cancer who registered in cancer registry center, Tehran-Iran, between December 21, 2001 andDecember 21, 2006 and all patients were followed by telephone contacts. The Kaplan-Meier method was performedto describe survival curves and log-rank test to compare the survival rate in subgroups. Cox regression wasused to determine the prognosis factors. Results: The mean age was 57.9 ± 11.9 years and 72.6% of patientswere male. Tumor size (>35mm) and lymph node metastasis were established as significant factors for survivalof patients with EGC in both univariate and multivariate analysis. Conclusion: The findings of this studyindicate that lymph node metastasis and tumor size are the most independent prognostic factors in these patients.     

Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer

Early gastric cancer without lymph node metastasis has been reported after the analysis of many cases, and a consensus has been reached about this condition. We report two cases of node-positive differentiated sm1 gastric cancer without lymphatic invasion into the submucosal layer. Case 1 was a 73-year-old man who underwent EMR for 0-IIc early gastric cancer (EGC) on the gastric angle, with a histological diagnosis of tub1. Pathological examination revealed a 0-IIc lesion that was 12 mm in size and sm1 in invasion depth without lymphatic-vascular invasion. However, the infiltration in the submucosal layer was relatively wide. The patient subsequently underwent distal gastrectomy with D2 lymph node dissection. Pathological examination revealed level 2 lymph node metastasis. Case 2 was a 62-year-old woman who underwent ER for a 0-I+IIc-type EGC on the greater curvature of the antrum, with a histological diagnosis of tub1. Pathological examination revealed a 0-I+IIc-type lesion that was 15 mm in size and sm1 in depth. Lymphatic invasions in the muscularis mucosa were found, but none were seen in the submucosal layer. Two years later, follow-up computed tomography (CT) showed a lymph node swelling in the infrapyloric region. Distal gastrectomy with D2 dissection was then performed, and pathological examination revealed level 1 lymph node metastasis. Although the lesions in both patients satisfied the criteria of Gotoda et al. for minimal risk of nodal involvement, lymph node metastasis was observed in these patients. Curative surgery with lymph node dissection is thus required in patients with wide infiltration of the submucosal layer or lymphatic invasion in the muscularis mucosa.     

Usefulness of preoperative FDG-PET for detection of gastric cancer

Background Positron emission tomography (PET), using 18F-fluoro-2-deoxy-d-glucose (FDG) as a tracer, can detect malignant neoplasms with altered glucose metabolism. To clarify the usefulness of FDG-PET for detecting gastric cancer, we evaluated preoperative PET imaging in gastric cancer patients. Methods Sixty-two gastric cancer patients who underwent FDG-PET imaging and gastric resection with lymphadenectomy were evaluated. Results For primary tumor assessment by PET, detection rates were significantly different in the following order: tumor size 30 mm or more (76.7%) > tumor size less than 30 mm (16.8%); advanced gastric cancer (AGC, 82.9%) > early gastric cancer (EGC; 25.9%); with nodal involvement (79.3%) > without nodal involvement (39.4%). In EGCs, the detection rate of the intestinal type, according to Lauren's classification (43.8%) was significantly higher than that of the diffuse type (0%). Two of the 7 EGC patients who were PET-positive had nodal involvement and their tumors were the intestinal type. For the assessment of nodal involvement, the accuracy of nodal involvement detection was 67.7% with PET and 75.8% with computed tomography (CT). Preoperative FDG-PET revealed colon cancer in 2 patients, adrenal tumor in 1 patient, lung cancer in 1 patient, and lung metastasis in 1 patient. Conclusion Larger or more advanced tumors with nodal involvement had a higher detection rate by PET. In EGCs, only the intestinal type was detectable by PET. PET-positive EGC may be aggressive, and an adequate lymphadenectomy must be done. Preoperative PET was useful for the detection of other malignancies and distant metastasis.     

低张水灌肠螺旋CT双期增强扫描对结肠癌术前分期的应用价值

目的探讨低张水灌肠螺旋CT双期增强扫描对结肠癌术前TNM分期的准确性及临床应用价值。方法选择广东省阳春市人民医院2012年1月_2013年5月,有完整影像和病理资料的结肠癌患者62例,回顾性分析CT影像在肿瘤的部位、肠壁侵犯的深度范围、周围脂肪问隙的变化、淋巴结及远处器官转移等特点,并与手术及术后病理对照,分析低张水灌肠螺旋CT双期增强扫描对结肠癌术前TNM分期的准确性。结果低张水灌肠螺旋CT双期增强扫描对结肠癌T分期准确率90．32％（56／62）,N分期准确率80．64％（50／62）,M分期准确率100％（62／62）。结论低张水灌肠螺旋CT双期增强扫描能准确显示结肠癌的部位、确定肿瘤侵犯的深度范围、淋巴结和远处器官转移,更准确的诊断结肠癌和术前分期评估,可以作为结肠癌术前的首选检查方法。