胃癌腹膜腔种植转移的MSCT表现

The MSCT findings of peritoneal dissemination from gastric cancer

目的:探讨胃癌腹膜腔种植转移的多层螺旋CT影像特征。方法:收集经手术探查和腹膜腔穿刺证实为腹膜腔转移的胃癌患者的腹部CT图像。分析CT图像上肠壁增厚部位和增强方式,网膜、系膜有无增厚、结节以及增强方式,有无腹水以及分布部位,肾盂输尿管积水以及有肝脾转移等。对接受2次以上CT复查者,观察CT表现的变化。结果:胃癌腹膜腔转移104例,男67例,女37例。73例显示结肠肠壁增厚,其中71例增厚肠壁有强化,31例呈层状强化。42例显示直肠肠壁增厚,其中41例强化,25例显示层状强化。55例发现腹膜腔积液。3例显示网膜或系膜增厚,14例显示网膜或系膜结节影。肾盂输尿管积水27例,胸腔积液6例,腹腔肿块2例。结论:胃癌腹膜腔种植转移的CT表现为大肠壁增厚和肠壁环形强化、腹膜腔积液与肾盂输尿管积水。腹膜增厚、网膜结节和腹腔肿块发生率低。

Objective： To investigate CT findings of peritoneal dissemination from gastric cancer. Methods： CT findings of peritoneal dissemination from gastric cancer confirmed by surgical operation or peritoneal biopsy were reviewed by the consensus of two experienced radiologists. The findings were evaluated as follows： the presence of thickening of the colorectal wall and its pattern of enhancement, the thickening and nodule of omentum, peritoneum, ligament and its pattern of enhancement, the presence of lymph node swelling and mass in the abdominal cavity, ascites and distribution, hydronephrosis or hydroureter, liver or spleen metastasis, etc. For cases which CT examination more than once, changes were observed. Results： There were 104 cases of peritoneal dissemination from gastric cancer, including 67 males and 37 females. 73 were found with colon wall thick ened, among which 71 cases were enhanced and 31 cases were layering enhanced. 42 cases with rectum wall thickening were revealed on MSCT, in which 41 cases were enhanced and 95 cases were revealed as layering pattern. CT also revealed ascites in 55 patients. Pleural effusion was found in six patients. Omenta or mensentary were remarkably thickened in three cases and nodule in 14 cases. Hydronephrosis and hydroureter were found in 27 patients. Tumor masses were found in two cases and hepatic metastasis in one patient. Conclusion： CT findings of peritoneal dissemination from gastric cancer manifest as thickened bowel wall with typically concentric layering howel wall thickening, as called target sign, ascites, hydronephrosis and hydroureter. Thickening of omentum or mesentery, nodule in omentum or mesentcry and mass in peritonium are relatively rare.