进展期胃癌和胃淋巴瘤的MSCT影像学鉴别

目的：分析探讨多层螺旋CT（MSCT）在进展期胃癌和胃淋巴瘤鉴别诊断中的价值。方法对46例进展期胃癌和34例胃淋巴瘤患者的MSCT平扫和增强扫描影像学资料进行分析，比较两种肿瘤在胃侵犯部位、胃壁胃黏膜及胃腔改变、周围组织及器官的浸润或转移、中上腹部淋巴结转移等方面的差异。结果进展期胃癌组多部位侵犯14例，增强扫描不均匀强化28例，胃黏膜中断、破坏24例，胃腔狭窄、近侧胃腔扩张14例，腹主动脉周围下部淋巴结转移18例；胃淋巴瘤组多部位侵犯24例，增强扫描不均匀强化7例，胃黏膜中断、破坏5例，胃腔狭窄、近侧胃腔扩张3例，腹主动脉周围下部淋巴结转移23例；两组上述指标差异均有统计学意义（P＜0.05或P＜0.01）。进展期胃癌组和胃淋巴瘤组在胃壁厚度、肿瘤外侵和器官转移、平均淋巴结转移的部位数等差异无统计学意义（P＞0.05）。结论 MSCT可清晰显示进展期胃癌和胃淋巴瘤的侵犯部位、侵犯程度的不同，对于二者的鉴别具有重要价值。

Differential diagnostic value of MSCT on advanced gastric cancer and gastric lymphoma

Objective To investigate the differential diagnostic value of multi slice spiral CT (MSCT) on ad-vanced gastric cancer and gastric lymphoma. Method 46 patients with advanced gastric cancer and 34 patients with gastric lymphoma underwent MSCT plain scan and enhanced scan. The differences of the stomach invasion site, stom-ach wall changes, gastric mucosa and cavity changes, surrounding tissue or organ infiltration or metastasis and upper abdominal lymph node metastasis between the two kinds of tumors were compared. Result For advanced gastric can-cer group, 14 cases had multiple sites invaded, 28 cases had inhomogeneous enhanced scan, and 24 cases had gastric mucosa injury, 14 cases had stenosis of stomach and proximal gastric lumen dilatation, 18 cases had lower abdominal paraaortic lymph node metastasis. For gastric lymphoma group, 24 cases had multiple sites invaded, 7 cases had inho-mogeneous enhanced scan, 5 cases had gastric mucosa injury, 3 cases had stenosis of stomach and proximal gastric lumen dilatation, 23 cases had lower abdominal paraaortic lymph node metastasis, there were statistically significant differences in above indexes between the two groups (P<0.05 or P<0.01), while both groups were similar in the gas-tric wall thickness, tumor invasion and organ metastasis, and the average number of lymph node metastasis sites (all P>0.05). Conclusion MSCT reveals differences in sites and degrees of invasion between advanced gastric cancer and gastric lymphoma clearly, which is of clinical importance in differential diagnosis.