3.0TMRI与64层螺旋CT在进展期胃癌术前T分期的诊断价值比较

目的：探讨3.0T MRI 与64层螺旋 CT 在进展期胃癌术前 T 分期中的诊断价值。方法对经胃镜病理证实的胃癌患者40例,于术前1周行 MSCT 及 MRI 检查,根据影像学资料进行 T 分期,并与术后病理结果进行对照。结果MRI 与 MSCT 术前 T分期与术后分期均有较好的一致性(Kappa-test ,P <0.05),MRI 与 MSCT T 分期的准确率分别为77.5%、72.5%,经统计学分析2种检查方法之间无统计学差异(McNemar-test ,P >0.05)。结论MRI 与 MSCT 在进展期胃癌术前 T 分期中诊断价值相当,MRI的诊断准确性稍高于 MSCT,尤其是在区分 T3、T4期具有潜在的优势。     

A SURVIVAL ANALYSIS OF 572 CASES OF NPC WITH CT-SCAN BEFORE TREATMENT It APPRAISAL OF THE T-STAGING SYSTEMS

鼻咽癌的临床分期目前应用较广泛的有国际抗癌联盟法,日本京都会议法以及中国长沙法。本研究已报告的第一部分指出鼻咽癌的T分期必须参照横断面扫描才能准确,并提出了一些以C T扫描为基础的T分期依据。本文在此基础上,从鼻咽癌局部扩展的模式,结合对上述分期法的T分期生存率曲线的评价来探讨T分期。结果表明京都会议的T分期基本符合鼻咽癌的局部生长、扩展模式和能正确反映预后,但其T_3亚分期意义不大,并对其T_1、T_2分期标准提出了较明确的定义。     

肝门部胆管癌改良T分期临床应用价值探讨(附127例回顾性分析)

目的探讨肝门部胆管癌术前改良T分期系统的临床应用价值。方法按术前改良T分期系统回顾分析中山大学第一医院2001年1月至2006年12月收治127例肝门部胆管癌病人的临床资料。结果T1期75例，他期19例，仍期33例；其切除率分别为61．33％，52．63％，21．21％；根治性切除率分别为40．63％，30．77％，6．90％，均随T分期增高而下降（均P〈0．01）。T1期1、3、5年存活率分别为55．9％、37．7％、30．1％，他期1年为37．5％，T3期1、2年为48．1％、12．0％。用Log—rank法比较差异无显著性意义；用Breslow法比较T1期与他期差异有显著性意义，他与期T3期、T1期与T3期比较差异无显著性意义。结论T分期系统有较好的术前评价作用，可用于判断肝门部胆管癌可切除性及手术方式选择，但仍有待完善。     

The Role of Three-Dimensional Multidetector CT Gastrography in the Preoperative Imaging of Stomach Cancer: Emphasis on Detection and Localization of the Tumor

Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.     

3．0TMR T2WI序列与增强T1WI序列对鼻咽癌T分期的价值

目的比较3.0TMR T2WI脂肪抑制（fat supptession,FS）序列与增强后T1WI脂肪抑制序列对鼻咽癌T分期的诊断价值。方法对76例鼻咽镜活检证实的鼻咽癌患者采用3.0TMR依次进行平扫、动态增强及FSE-T1-FS（fast spin echo,FSE）增强扫描,平扫包括横断位FSE—T2-FS序列,增强扫描采用横断位LAVA（liver acquisition with volume acceleration,肝脏加速客积采集）序列动态增强扫描及随后的横断位FSE—T1-FS增强扫描。用平扫横断位FSE-T2-FS序列、LAVA序列动态增强扫描及FSE—T1-FS序列增强扫描对鼻咽癌周围结构侵犯进行评估。采用McNemar法对横断位平扫FSE—T2-FS序列及LAVA序列动态增强扫描判断鼻咽癌周围侵犯情况进行统计学分析。结果LAVA序列动态增强扫描序列评价腭帆张提肌、头长肌、咽旁间隙、蝶窦、上颌窦、翼腭窝、翼内肌、翼外肌、翼突、海绵窦、颅内的侵犯优于FSE-T2-FS序列,其中对判断腭帆张提肌及翼腭窝的侵犯存在显著性差异。同时,LAVA序列动态增强扫描在咽旁间隙及翼腭窝受侵的判断优于FSE—T1-FS序列增强扫描。结论与平扫FSE—T2-FS序列相比,增强扫描能够更加清楚显示鼻咽癌的边界和侵犯范围,而采用LAVA序列动态增强扫描显示鼻咽癌周围结构侵犯优于或等于FSE-T1-FS增强扫描序列。     

Clinico-pathological correlation of T3 glottic carcinomas

Controversy surrounds the relative merits of radiotherapy and laryngectomy for the treatment of T₃ glottic carcinoma. In this study of 82 patients with non-irradiated T₃ glottic carcinomas managed by total laryngectomy, 45% had been clinically understaged and were pT₄. There was a significant association between subglottic extension and tracheostomy with understaging. A trend to understage anterior commissure tumours was also evident. Nodal status did not influence understaging and therefore should not determine the choice of treatment of the glottic primary. Laryngectomy is recommended for patients with subglottic extension or a tracheostomy. If radiotherapy is to be used for the remaining tumours, then vigilance against understaging is required.     

T-staging of gastric cancer of air-filling multidetector-row CT: Comparison with hydro-multidetector-row CT

Purpose

The purpose of this study was to evaluate the accuracy of T-staging of gastric cancer by air-filling multidetector-row CT (air-MDCT) compared with water-filling MDCT (hydro-MDCT).

Materials and methods

One hundred fifteen patients with histologically diagnosed gastric cancer were included in this study. Fifty-eight patients underwent air-MDCT, and the remaining 57 had hydro-MDCT using a 64-channel scanner. Based on the volumetric data of contrast-enhanced MDCT obtained about 75 s after intravenously injecting 525 mg iodine per kilogram patients weight (525 mgI/kg) nonionic contrast material at the rate of 2 ml/s, oblique coronal and oblique sagittal multi-planar reformatted images perpendicular to the stomach wall, including the tumor, were reconstructed on a workstation. Mural invasion of gastric cancer into the gastric wall, as visualized by CT, was classified according to the TNM classification, and the results of T-staging by MDCT were compared with those by pathologic analysis after surgery.

Results

Correct assessment of T-staging by air-CT was achieved in 48 of 58 patients (83%), and that by hydro-MDCT was 49 of 57 patients (86%). The sensitivity, specificity, and accuracy of the technique in determining the invasion of serosa were 88%, 93%, and 91% for air-CT and 83%, 95%, and 91% for hydro-CT. There were no significant differences between hydro-MDCT and air-MDCT in sensitivity (P = 0.73), specificity (P = 0.71) and accuracy (P = 0.98).

Conclusion

Air-MDCT is a very valuable tool in T-staging of gastric cancer as well as hydro-MDCT.     

鼻咽癌的MRI分期诊断价值

目的：探讨MRI对鼻咽癌分期的价值。材料与方法对比分析135例鼻咽癌病人的MRI分期与常规临床分期的结果。结果：49例病人（36％）的MRI分期与临床常规分期结果相同；86例病人（64％）的MRI分期结果上升，其中由临床分期的T2升为T3或T4占54％，由T3升为T4占31％。结论：MRI检出更多的肿瘤早期的超腔侵犯，可使鼻咽癌的分期更加准确。     

Improvement in T-staging of rectal carcinoma: using a novel endorectal ultrasonography technique with sterile coupling gel filling the rectum

Our purpose was to study the accuracy of using endorectal ultrasonography (ERUS) with sterile coupling gels filling the rectum in the preoperative T-staging of rectal carcinoma. A total of 189 patients with confirmed rectal carcinoma were recruited. All underwent ERUS and surgery within the week following sonography. EURS was performed by introducing sterile coupling gel into the rectum. Two radiologists looked at the images at the same time and agreed upon staging. Rectal carcinoma was staged from Tis to T4. The accuracy of T-staging by ERUS was 89.95%. The sensitivity, specificity, PPV and NPV for ERUS at different stages were calculated. For early stage (Tis and T1), these values were 93.62%, 97.89%, 93.62% and 97.89%, respectively. ERUS filling with sterile coupling gel in the rectum overcomes the pressure effect from a water bath and the restriction caused by tumor stenosis, thus, greatly improving the accuracy of T-staging. The examination is real-time, safe and inexpensive.     

超声内镜对早期结直肠癌的诊断价值分析

目的 探讨超声内镜用于早期结直肠癌T分期的准确性及影响因素。方法 顺序纳入2017年9月至2021年6月于首都医科大学附属北京友谊医院住院并行内镜切除的早期结直肠癌患者186例(200灶),收集临床信息、病理诊断、普通内镜以及超声内镜表现。参照病理分期,分析超声内镜的诊断效能,并采用Logistic回归模型分析影响超声内镜诊断准确率的因素。结果 超声内镜对早期结直肠癌浸润深度诊断的总体准确率为75.0%(150/200),对黏膜内癌和黏膜下层浸润癌的准确率分别为85.0%和35.0%。单因素分析显示,超声内镜诊断准确性与病变部位、大小、形态无关,而与组织学类型、病变深度相关(P<0.001)。多因素分析显示,组织学类型是深度判断错误的危险因素,当肿瘤为中低分化腺癌、黏液腺癌及印戒细胞癌时准确率显著降低(P=0.019)。结论 超声内镜可用于辅助判断早期结直肠癌的浸润深度,肿瘤有中低分化或未分化成分时准确率降低。