螺旋CT增强扫描对进展期胃癌的局部浸润和淋巴结转移的研究

目的:探讨螺旋CT增强扫描在判定进展期胃癌局部浸润和胃周淋巴结转移上的应用价值。材料与方法:对56例进展期胃癌的局部浸润和胃周淋巴结转移情况进行螺旋CT诊断,并与手术病理对照。结果:依据癌肿对应局部浆膜面征象、脂肪间隙征象、癌肿局部突出征象判定癌肿穿透浆膜的准确度分别为82.14%,60.71%和55.36%。动脉期癌肿线状强化、不均匀强化和团块状强化的穿透浆膜率分别为7.14%,52.17%和89.47%。静脉期癌肿线状强化、不均匀强化和团块状强化的穿透浆膜率分别为7.14%,53.85%和93.75%。螺旋CT增强扫描判定胰腺、横结肠及其系膜、脾受累的准确度分别为87.5%,87.5%和92.86%。支持以直径9mm作为螺旋CT增强扫描诊断胃周淋巴结转移的直径标准(P<0.05)。多种胃癌生物学行为CT影像特征与癌肿对应淋巴结转移率密切相关(P均<0.05)。结论:应用螺旋CT增强扫描检查进展期胃癌的局部浸润和淋巴结转移情况,对于指导手术和制定综合治疗方案具有重要意义。

Study of local invasion and metastases of lymph nodes in advanced gastric carcinoma by contrast enhanced spiral CT

Objective: To evaluate the value of contrast enhanced spiral CT in the detection of local invasion and metastases of lymph nodes in advanced gastric carcinoma(AGC). Methods: The CT results of local invasion and metastases of lymph nodes in 56 AGC were compared with surgical and pathological findings. Results: The accuracy of judging serous infiltration by localized serous sign, by fat interval sign and by neoplastic localized protruded sign were 82.14%, 60.71% and 55.36% respectively. In arterial phase, serous infiltration appeared as streak-like; inhomogeneous and mass-like enhancement were 7.14%, 52.17% and 89.47% respectively. In the venous phase serous infiltration appeared as tumor streak-like enhancement, inhomogeneous and mass-like enhancements were 7.14%, 53.85% and 93.75% respectively. The accuracy of detecting the involvement of pancreas, transverse colon with its mesentery and spleen by contrast enhanced CT were 87.5%, 87.5% and 92.86% respectively. The criteria for the diameter of metastatic lymph node was 9mm(P<0.05). Conclusion: Some CT findings reflecting biological behavior of AGC were correlative to the metastatic rate of adjacent lymph nodes. Enhanced spiral CT is valuable in detecting advanced gastric carcinoma with localized infiltration and lymph node metastases and also valuable to surgical intervention and treatment planning.