多层螺旋CT对胃癌术前TNM分期的诊断价值

目的利用多层螺旋CT(MSCT)前瞻性地对胃癌进行术前TNM分期并与病理结果对照,确定CT在术前分期中的作用并指导临床治疗。方法经胃镜证实的310例胃癌患者,于术前1周内行MSCT检查,所有患者在空腹或禁食4h后行MSCT检查。平扫后进行动态三期增强。术前MSCT检查由两名资深放射科医生双盲法进行TNM分期,评定时根据需要进行多平面容积重建(MPVR)重建。结果MSCT对于胃癌T分期的总体判断准确率为80.0%,其中T1期准确率65.8%、T2期61.5%、T3期88%和T4期85%。MSCT对N分期的判断准确率为72.2%,其中N075.0%、N168.7%和N272.3%。对总体N的敏感性和特异性分别为86.0%和75.0%。MSCT对远处转移判断准确率为92.7%,敏感性和特异性分别为69.2%和97.6%。对胃癌TNM总体判断准确率为63.4%。结论动态三期增强MSCT薄层扫描可较准确地显示正常胃壁结构及胃癌侵犯胃壁的深度,通过其在不同时相中的强化特点显示病变累及的范围,同时可反映淋巴结转移情况,并对远处脏器的转移和播散做出较为准确的TNM分期。

TNM Staging of Gastric Cancer by Multislice Spiral CT

Objective To assess the accuracy of dynamic multislice spiral CT(MSCT) in the preoperative TNM staging of gastric cancer. Methods MSCT was performed in 310 patients with of gastric cancer diagnosed by biopsy prior to operation, and all of them subsequently underwent surgery. All findings were prospectively analyzed by two doctors separately and correlated with pathological findings in surgery. Results In comparison with histologic results, the accuracy for T staging detected with MSCT was 80.0%: 65.8% for T_1, 61.5% for T_2, 88% for T_3 and 85% for T_4. The accuracy of MSCT for N staging was 72.2% (N_ 0 75.0%, N_ 1 68.7%, N_ 2 72.3%), sensitivity and specificity were 86.0% and 75.0%, respectively. The accuracy of MSCT for M staging was 92.7% with sensitivity 69.2% and specificity 97.6%. The overall accuracy in TNM staging was 63.4%. Conclusion Dynamic enhanced MSCT scan plays a very important role in TNM staging as far as clear demarcation of primary lesions, enlarged lymph nodes and distant metastases are concerned.