胃癌浆膜面的不同CT表现及其诊断意义

目的探讨胃癌浆膜面不同CT表现类型以及据此判断浆膜有无侵犯的价值及临床意义。方法回顾性分析接受根治性切除的进展期胃癌患者141例,将胃癌浆膜面CT表现分为5种类型:光滑型(Ⅰ型)、光滑膨隆型(Ⅱ型)、毛糙型(Ⅲ型)、结节型(Ⅳ型)和血管包绕型(Ⅴ型)。光滑型诊为浆膜无侵犯,其余类型诊为浆膜侵犯。将CT和术中判断胃癌浆膜侵犯结果与病理相对照。结果 CT和术中判断胃癌浆膜有无侵犯的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为88.76%(79/89)、65.38%(34/52)、81.44%(79/97)、77.27%(34/44)、80.14%(113/141)和98.88%(88/89)、34.62%(18/52)、72.13%(88/122)、94.74%(18/19)、75.18%(106/141)。CT判断浆膜无侵犯的特异度高于术中判断(χ2=9.85,P<0.05)。术中判断浆膜侵犯的敏感度高于CT(χ2=7.85,P<0.05)。CT胃癌浆膜面光滑型、光滑膨隆型、毛糙型、结节型和血管包绕型浆膜侵犯率分别为22.73%(10/44)、46.15%(6/13)、83.61%(51/61)、85.71%(6/7)和100%(16/16),差异有统计学意义(χ2=42,P<0.001)。结论血管包绕型是CT诊断胃癌浆膜侵犯的可靠征象;CT浆膜面表现为光滑膨隆型时,判断胃癌浆膜侵犯要慎重。

CT findings of serosa and their diagnostic significances of gastric cancer

Objective To explore the value of different serosal types of gastric cancer observed on CT in judging serosal invasion.Methods Totally 141patients of gastric cancer who underwent radical surgery were retrospectively analyzed.Serosal appearances on CT were classified into 5types.Smooth-type was diagnosed as negative serosal invasion,and the others were diagnosed as serosal invasion.The results of CT observation and intraoperative observasion for serosal invasion of gastric cancer were compared with pathological results.Results The sensitivity,specificity,positive predictive values,negative predictive values,accuracy of CT and intraoperative diagnosis of serosal invasion was 88.76%(79 / 89),65.38%(34 / 52),81.44%(79 / 97),77.27%(34 / 44),80.14%(113 / 141),and 98.88%(88 / 89),34.62%(18 / 52),72.13%(88 / 122),94.74%(18 / 19),75.18%(106 / 141),respectively.The specificity of CT was higher than that of intraoperative diagnosis(χ 2 =9.85,P<0.05).The sensitivity of intraoperative diagnosis was higher than that of CT(χ 2 =7.85,P <0.05).The rate of serosal invasion of smooth type,smooth-bulge type,rough type,nodular type and vessel-wrapped type was 22.73%(10 / 44),46.15%(6 / 13),83.61%(51 / 61),85.71%(6 / 7) and 100%(16 / 16),respectively(χ 2 = 42,P<0.001).Conclusion Vessel-wrapped type is reliable in predicting serosal invasion of gastric cancer.Carefulness should be paid for gastric cancer with smooth-bulge type on CT.