螺旋CT对胃癌淋巴结转移的评价

Evaluation of lymph node metastases in gastric cancer with spiral computed tomography

目的:探讨胃癌淋巴结转移的螺旋CT特征,从而指导临床合理地制订治疗方案和进行预后分析.方法:回顾性分析经手术病理证实的45例胃癌全阴组和全阳组淋巴结的影像资料,并与病理进行对照研究.结果:螺旋CT检出病理诊断为全阳组和全阴组的各组淋巴结共267个,其中阳性淋巴结有123个,阴性淋巴结有144个.如以平扫CT值≥25Hu或动脉期CT值≥70Hu或静脉期CT值≥80Hu为诊断阳性淋巴结标准,则阳性淋巴结的敏感性高达98.4%,阳性预测值为70.0%;特异性为69.3%,阴性预测值为97.9%.结论:螺旋CT对判断胃癌有无淋巴结转移有重要作用.如以平扫CT值≥25Hu或动脉期CT值≥70Hu或静脉期CT值≥80Hu为诊断阳性淋巴结标准,则将大大提高对淋巴结转移的诊断.

AIM： To investigate the manifestation characteristics of spiral computed tomography （SCT） for lymph nodes metastases in gastric cancer, and to provide the evidence for clinicians to make appropriate treatment strategies and prognosis analysis. METHODS： The SCT findings for lymph nodes in 45 gastric cancer patients with or without metastasis were confirmed by surgical pathology, and then retrospectively analyzed. RESULTS： A total of 267 lymph nodes （positive 123, negative 144） were detected by SCT and confirmed by pathology in metastasis-positive or metastasis-negative patients. If the attenuation values, more than or equal to 25 Hu in plain scan or 70 Hu in arterial phase or 80 Hu in venous phase, were used as the threshold to detect the metastasisositive lymph nodes, the sensi-tivity, the positive predictive value, the negative predictive value and the specificity were 98.4%, 70.0%, 97.9% and 69.3%, respectively. CONCLUSION： SCT is valuable in judging the metastasis in gastric cancer. The application of attenuation values more than or equal to 25 Hu in plain scan or 70 Hu in arterial phase or 80 Hu in venous phase can dramatically improve the diagnosis for lymph node metastasis in gastric cancer.