穿透性胃溃疡恶变12例影像学分析

目的提高对穿透性胃溃疡恶变的影像学诊断及鉴别诊断的认识。方法经手术病理证实的12例穿透性胃溃疡恶变病例，均行胃钡餐造影，10例加行CT扫描。结果胃钡餐造影出现深大龛影12例，其中腔外龛影10例，部分腔内龛影2例，出现穿孔2例。CT见胃壁增厚8例，胃内软组织块影2例，胃外软组织块影2例，腹腔、肝门、腹膜后淋巴结肿大6例。结论胃钡餐造影对穿透性胃溃疡有良好的显示，还可以发现CT显示不理想的胃黏膜面，对估计病变的范围和溃疡、穿孔方面优于CT。但CT能清楚观察胃壁的厚度、胃外肿块、与周围脏器的关系以及胃外有无淋巴结肿大，能对判断穿透性胃溃疡有无恶变等提供更多准确的信息。

Imaging analysis of malgnant transformation of penetrating stomach ulcer:Analysis of 12 cases

Objective To improve the understanding of imaging dianosis and differential diagnosis of malignant penetrating stomach ulcer. Methods Twenty patients with malignant penetrating stomach ulcer were confirmed by surgicopathology. Gastris barium sulfate examination was performed in 12 cases and CT scan in 10 cases. Result In gastric barium sulfate examination, there was deep and large niche shadow in 12 cases, including extragastric niche shadow in 10 cases, partial intragastric niche shadow in two cases, and perforation in two cases. In CT scan, thickened gastric wall was seen in eight cases, intragastric parenchymal lump in two cases, extragastric parenchymal lump in two cases, and peritoneal, hepatic portal, and retroperitoneal lymph node intumescence in six cases. Conclusion Gastric barium sulfate examination can reveal penetrating stomach ulcer in a good manner, and can find gastric mucosa which is difficult to reveal by CT scan. It is superior to CT scan in finding ulcer and perforation. Nevertheless CT scan can display gastric wall thickness, extragatris parentoneal lump, the relation with surrouding viscera and extragastric lymph existence of node intmeseenee. It can provide more detailed information for judging whether penetrating stomach ulcer had turned malignant.