对比增强超声造影对胃下部癌区域淋巴结转移的预测价值

目的：探讨对比增强超声造影对胃下部癌区域淋巴结转移的预测价值。方法采用六氟化硫微气泡造影剂和连续实时成像对比脉冲序列技术，对250例经胃镜活检确诊的胃下部癌患者术前行超声造影及螺旋CT检查，诊断区域淋巴结转移情况，并与术后病理检查结果对比。结果对比增强超声造影预测胃下部癌区域淋巴结转移的准确率、敏感度、特异度、Youden指数分别为71.2%、70.3%、88.5%、0.588，螺旋CT预测结果分别为71.4%、66.4%、89.9%、0.563，两者预测区域淋巴结转移准确率的差异均无统计学意义（均P＞0.05）。两者联合应用的预测准确率为82.5%。对比增强超声造影预测第3、8a、8p组淋巴结转移准确率明显高于螺旋CT；预测第1、11p组淋巴结转移准确率明显低于螺旋CT，差异均有统计学意义（P＜0.05或0.01）。结论对比增强超声造影预测胃下部癌区域淋巴结转移具有一定的价值；对比增强超声造影联合螺旋CT检查可提高预测胃下部癌区域淋巴结转移的准确率。

Contrast-enhanced ultrasonography in diagnosis of regional lymph node metastasis in the lower third gastric cancer

Objective To evaluate contrast- enhanced ultrasonography （CEUS） in diagnosis of regional lymph node metastasis in the lower third gastric cancer. Methods A sulfur hexafluonde- fil ed microbubble ultrasound contrast agent and a continuous real- time imaging technique of contrast pulse sequencing were used.Two hundred and fifty patients with lower third gastric cancer confirmed by biopsies, who received preoperative CEUS and MSCT examinations, were enrol ed in this study. The results of lymph node metastasis detected by CEUS were compared with postoperative pathological findings. Results The accuracy, sensitivity, specificity and Youden Index of CEUS and MSCT in assessment of lymph node metastasis were 71.2%, 70.3%, 88.5% and 0.588;71.4%, 66.4%, 89.9%and 0.563, respectively. There was no significant difference in the accuracy of assessment of lymph node metastasis（χ^2=2.86, P〉0.05）. The accuracy of CEUS combined with MSCT was 82.5%. The accura-cies of CEUS in assessment of the No.3, 8a, 8p groups were higher than those of MSCT, while the accuracies of the No.1, 11p groups were lower than those of MSCT （P〈0.05）; there were no significant differences in other groups （P〉0.05）. Conclusion DCUS combined with MSCT can improve the diagnostic accuracy of regional lymph node metastasis in the lower third of gastric cancer.