多层螺旋CT在胃癌检出及TNM分期中的应用价值

目的:探讨多层螺旋CT(MSCT)在胃癌检出及术前TNM分期中的应用价值.方法:50例进展期胃癌患者,术前均行MSCT、超声(US)、胃镜(FG)、钡剂造影(GI)检查,4种方法分别独立作出诊断并与手术病理结果对照,计算各种检查方法对胃癌的检出率并进行比较.40例MSCT和US均检出胃癌,两种方法术前分别进行TNM分期,与手术大体标本、病理结果相对照,比较两者对病灶分期判断的准确率.结果:MSCT、FG、GI、US检查对50例进展期胃癌检出率分别为98%、100%、86%、80%,MSCT的检出率与FG相比无明显差异,但明显高于GI和US(P<0.05,P<0.01).MSCT对40例胃癌术前TNM分期准确率为92.5%(37/40),明显高于US的72.5%(29/40)(P<0.05).结论:运用MSCT薄层多期扫描、多平面重建(MPR)及三维容积重建(VR),对胃癌检出、显示癌肿大体类型、肿块大小、部位判断、对邻近脏器累及程度和远处脏器转移上具有明显优势,可明显提高进展期胃癌检出率及TNM分期的准确性.

Clinical value of multislice CT in diagnosis and preoperative TNM-staging of gastric carcinoma

Objective: To evaluate the clinical value of multislice CT (MSCT) in the diagnosis and preoperative TNM staging of gastric carcinoma. Methods: Fifty patients with advanced gastric carcinoma were examined by MSCT, gastrointestinal series (GI), fiberoptic gastroscopy (FG) and transabdominal ultrasonography (US). The results of the 4 methods were compared with postoperative pathological results. Forty patients, who were diagnosed as having advanced gastric carcinoma by both MSCT and US, had their TNM staging evaluated and the results were compared with postoperative pathological TNM evaluation. Results: The detection rates of MSCT, FG, GI and US for advanced gastric carcinoma were 98%, 100%, 88% and 80%, respectively. The detection rate of MSCT was not significantly different with that of FG, but was obviously higher than that of GI (P=0.027) and US (P=0.004). The accuracy of MSCT in preoperative TNM staging was significantly higher than that of US(92.5% vs 72.5%). Conclusion: MSCT, with two-phase thin slice incremental scanning image, multiplaner reformats (MPR) and three-dimension (3D) image, is more advantaged in detecting the gross type, size, location, invasion and metastasis of advanced gastric carcinoma, thus greatly improving the detection rate and preoperative TNM staging of advanced gastric carcinoma.