多排螺旋CT在胃癌术前TN分期中的应用价值

目的:利用多层螺旋CT(MDCT),前瞻性的对胃癌进行术前TN分期,并与术后病理结果对照,评估其分期的准确性及临床价值。方法:对经胃镜证实的48例胃癌患者,于术前进行MDCT三期动态增强扫描。分别利用CT轴位图像和轴位结合多层面重组(MPR)图像对胃癌进行TN分期,并将CT分期结果与术后病理结果相对照,分期的准确性比较采用McNemar检验,取P<0.05为检验标准。结果:轴位和轴位结合MPR对胃癌病灶的检出率分别为91.6%(44/48)、97.9%(47/48)。轴位和轴位结合MPR对所有患者胃癌胃壁浸润深度(T分期)评估的准确率的分别为72.9%(35/48)、89.5%(43/48),两者之间差异具有统计学意义(P=0.041)。轴位和轴位结合MPR对所有患者转移淋巴结(N分期)评估的准确率的分别为72.9%(35/48)、77.1%(37/48),两者之间差异没有统计学意义(P=0.113)。结论:MDCT能对胃癌术前TN分期做出较准确的评估。MPR能显著改善胃癌T分期的准确率,但不能明显提高N分期的准确率。

Preoperative local staging of gastric cancer with 64-multidetector-row computed tomography

Objective：To prospectively evaluate accuracy of 64-multidetector-row computed tomography（MDCT） in the preoperative local staging of gastric cancer using histopathological rsults as reference standards. Methods：Forty-eight patients of gastric carcinoma diagnosed by biopsy underwent preoperative dynamic contrast-enhanced 64-MDCT scan.All received intramuscular injection of hypotonic agent（654-2） ten-minutes before CT scanning,and subsequently 800-1000 ml of tap water was orally administered.The images of all cases were evaluated on the axial CT images alone and in combination with multi-planar reformation（MPR） images respectively.The results were compared with pathology findings.Differences in accuracy of axial and MPR images for T and N staging were evaluated with the McNemar test.Statistical significance was inferred at P0.05. Results：The rates of 64-MDCT for detection of primary tumors were 91.6%（44/48）,97.9%（47/48） in the axial and combined axial and MPR images respectively.The overall accuracy for tumor invasion of gastric wall depth（T staging） was significantly better with combined axial and MPR images 89.5%（43/48） than with axial images alone 72.9%（35/48）,P=0.041.Regarding lymph node staging（N staging）,the accuracy of the axial and the combination of axial and MPR was as follows：72.9%（35/48） versus 77.1%（37/48）.This difference was not statistically significant（P=0.113）. Conclusion：64-MDCT can offer an early method for detection of gastric cancer and accurate preoperative tumor staging.The use of MPR images was superior to axial images alone in T staging but not for N staging.