胃原发性非霍奇金淋巴瘤与进展期胃癌的CT鉴别诊断

CT in the Differential Diagnosis of Primary Gastric Non-Hodgkin Lymphoma and Advanced Gastric Cancer

目的:探讨CT在胃原发性非霍奇金淋巴瘤与进展期胃癌鉴别诊断中的价值。方法:回顾性分析经手术病理证实的15例胃原发性非霍奇金淋巴瘤和22例进展期胃癌患者的病例资料,观察病变部位、形态、胃周径浸润范围、病灶最大厚度、坏死形态、病变强化程度及强化方式、浆膜面浸润、其它脏器浸润及腹部淋巴结转移情况等并进行对比分析。结果:胃原发性非霍奇金淋巴瘤胃壁厚度1.0～4.3cm(平均2.0cm),增强后动静脉期较平扫CT值分别提高10和20HU;胃壁完整10例,胃壁环周浸润3例,周围淋巴结肿大(直径>1.0cm)3例,腹腔少量积液2例。进展期胃癌胃壁厚度0.7～3.7cm(平均1.8cm),增强后动静脉期分别较平扫CT值提高20和40HU;胃壁溃疡17例,胃壁环周浸润3例,周围淋巴结肿大8例,其中2例伴钙化,腹腔大量积液3例、少量积液2例,腹腔脏器转移4例。两组病例均可出现胃周、肾门下腹膜后区淋巴结肿大。结论:CT在胃原发性非霍奇金淋巴瘤与进展期胃癌的鉴别诊断中有重要的价值。胃壁僵硬伴明显强化、浆膜外脂肪浸润、淋巴结肿大钙化、大量腹水及脏器转移等常提示胃癌的诊断;而胃壁增厚但柔软,伴轻度～中度均匀强化有助于胃原发性非霍奇金淋巴瘤的诊断。

Objective：To evaluate the value of CT in the differential diagnosis of primary gastric non-Hodgkin lymphoma （NHL） and advanced gastric cancer. Methods： CT images of 15 patients with primary NHL and 22 patients with advanced gastric cancer were retrospectively analyzed. All of the patients had pathology diagnosis. CT appearances included location,appearances of tumor, infiltration of stomach circumference, thickness of the lesion, pattern of necrosis, degree and pattern of enhancement, infiltration of serosa, invasion of other abdominal organs and abdominal lymphadenopathy of the two diseases were compared and analyzed. Results：Of the 15 NHL patients, the thickness of lesion ranged from 1.0~4.3cm （mean 2.0cm） ;compared with the CT value of lesion on plain CT, the CT value increased 10HU and 20HU respectively on arterial phase and portal vein phase after contrast enhancement. 10 cases showed intact gastric wall, 3 cases showed complete circumferential invasion, peri-gastric lymphadenopathy （d〉 1.0cm） were assessed in 3 cases and small amount of ascites in 2 cases. Of the 22 patients with advanced gastric cancer, the thickness of lesion ranged from 0. 7-3. 7cm （mean 1.8cm） ,increase of CT value in arterial phase and portal vein phase was 20HU and 40HU respectively. 17 cases had gastric ulcerative lesion,invasion of serosa in 18 cases,infiltration of whole gastric circumference in 3 cases. Peri-gastric lymphadenopathy （d〉1. 0cm） in 8 cases,of which 2 cases showed lymph node calcification. Large and small amount aseites were revealed in 3 eases and 2 cases respectively;4 cases had abdominal organ metastases. Metastatic lymph nodes located at the periphery of stomach and retroperitoneum below renal hilum could be found in both NHL and advanced gastric cancer. Conclusion：CT provided important information in the differential diagnosis of gastric non-Hodgkin lymphoma and advanced gastric cancer. CT findings including rigid gastric wall with marked enhancement,extra-serosal fat invasion,lymphadenopathy with calcification,large amount of aseites,abdominal organ invasion often suggests advanced gastric cancer. Thickened yet pliable gastric wall with mild or moderate homogeneous enhancement were in favor of the diagnosis of gastric NHL.