增强螺旋CT扫描技术在胃癌诊断和分期中的应用

Application of contrast-enhanced helical hydro-CT in diagnosing and staging gastric cancer

目的 探讨胃癌螺旋CT增强特征及增强扫描技术在胃癌诊断和分期中的作用。方法 对照分析50例胃癌患者的CT增强表现和术后的病理结果。患者CT扫描前30min饮水1000～1500ml，扫描前5～10min肌注山莨菪碱10mg，均行CT平扫和增强扫描。结果 胃癌的CT表现为胃壁局部或弥漫性增厚、软组织块影和固定的狭窄胃腔，部分病例合并癌性溃疡，并侵犯邻近组织，可有邻近或远处淋巴结肿大转移。病灶好发于贲门和胃窦部，增强扫描时病灶较平扫更明显，并有显著强化。CT分期的准确率达86％，淋巴结转移的检测率为60％。结论 螺旋CT增强扫描技术是诊断胃癌和对胃癌进行分期的一种可靠方法，有助于临床更好地治疗胃癌患者。

Objective To explore helical CT characteristics of gastric cancer and evaluate the diagnostic value of contrast-enhanced helical hydro-CT（HHCT）in staging gastric cancer. Methods The CT images of 50 patients with gastric cancer were retrospectively analyzed and correlated with pathologic findings at surgery. All patients were preoperatively imaged by plain and contrast-enhanced HHCT 30 min after drinking 500-1000 ml water. Peristalsis was minimized by intravenously administered spasmolytics. Results The characteristic findings of gastric career on CT images were focal or diffuse mural thickening, soft tissue masses, cancerous ulcers, stenosis of stomach, infiltration to adjacent tissues, lymph node metastasis and distant metastases. Strong contrast enhancement of the gastric wall was firmly related to gastric career. The loci of gastric career mainly located at the gastric cardia and gastric antrum, and became more prominent in contrast-enhanced HHCT than in plain HHCT.The accurate rate of contrast-enhanced HHCT for staging gastric career was 86% （43/50）, and the detection rate of lymph node metastases by CT was 60% （ 12/20）. Conclusion Contrast-enhanced HHCT is a reliable method for diagnosing and staging gastric career. It is a useful guide for surgeons to plan the best treatment for patients with gastric cancer.