多层螺旋CT对胃癌术前临床分期的评估价值

The values of multi-slice spiral CT in the preoperative stage assessment of gastric carcinoma

目的探讨多层螺旋CT(MSCT)在胃癌术前临床分期评估中的应用价值。方法对52例经胃镜活检证实的胃癌患者术前进行MSCT平扫和三期强化扫描,并进行三维显像,由两名高年资医师进行TNM分期,并与手术后病理结果对比。结果MSCT对胃癌T分期的总体诊断准确率为75.0%,其中T1期66.7%、T2期73.3%、T3期78.9%和T4期75.0%;对N分期的总体诊断准确率为71.2%,其中N0期66.7%、N1期72.0%和N2期72.2%;对M分期的总体诊断准确率为86.5%,其中M0期86.2%、M1期87.0%。MSCT对胃癌术前TNM分期与术后病理结果有着较高一致性(Kappa值=0.538-0.728,P<0.05)。结论MSCT可较准确地显示胃癌侵犯胃壁的深度,同时可反映淋巴结转移情况及远处脏器的转移,对于胃癌术前临床分期的评估上有其独特的优越性。

Objective To explore the value of multi - slice spiral CT（MSCT） in the preoperative stage assessment of gastric carcinoma. Methods MSCT was performed in 52 patients with gastric carcinoma diagnosed by biopsy before operation . The results of MSCT were prospectively analyzed by two doctors separately and compared with those of surgical pathological findings. Results In comparison with pathological results, the accuracy of MSCT for T stages was 75.0% ： 66.7% for T1,73.3% for T2,78.9% for T3 and 75.0% for T4, respectively. The accuracy of MSCT for N stages was 71.2% ： 66.7% for N0,72.0% for N1 ,72.2% for N2, respectively. The accuracy of MSCT for M stages was 86.5% ： 86.2% for M0 and 87.0% for M1. It shows concordance tendency between the preoperative TNM stages and surgical pathological findings. Conclusion MSCT plays a very important role in the assessment of invasion depth of gastric carcinoma as far as lymph nodes and distant organ metastases are concerned. It shows unique priority in the preoperative assessment.