多层螺旋CT鉴别胃常见恶性肿瘤的意义

Gastric Malignancies:Differentiation with Multi-detector CT

目的回顾性分析胃常见恶性肿瘤的CT表现,探讨MSCT鉴别胃常见恶性肿瘤的意义。资料与方法经手术病理证实的49例恶性胃肿瘤患者术前常规行MSCT增强扫描。两位放射科医师采用盲法对CT图像进行分析,评价病灶浸润胃壁的程度,病变处胃壁厚度,病灶累及范围,周围淋巴结肿大以及病变强化程度。结果49例中,29例(59.1%)为腺癌,8例(16.3%)为淋巴瘤,12例(24.5%)为恶性间质瘤。腺癌主要表现为局限胃壁增厚或弥漫性浸润伴黏膜强化。淋巴瘤表现为局限于黏膜和黏膜下层的多区域侵犯,伴胃壁明显增厚和周围肿大淋巴结。恶性间质瘤的特征为突出于胃壁外的巨大肿块。结论根据胃壁受累程度及侵犯区域,MSCT有助于鉴别三种较常见的胃恶性肿瘤。

Objective To retrospectively determine if gastric malignancies can be differentiated on multi-detector CT images on the basis of their morphologic features. Materials and Methods Between January 2006 and August 2007,49 patients （age range 21-87 yeas; 31 men,18 women） with gastric malignancies underwent preoperative CT included acquisition of contrast material-enhanced transverse and multiplanar reformation （MPR） images after water distention. Two radiologist reviewed CT studies in an independent and blinded fashion. The degree of mural invasion, gastric wall thickness, involved regions, perigastrie adenopathy and enhanced degree were evaluated. Pearson X2 test, multivariate logistic regression and Wilcoxon rank sum test were performed. Results In all the 49 gastrie malignancies included in this study, 29 （ 59.1% ） were adenocarcinoma; 8 （ 16.3% ） were lymphoma; 12 （ 24.5% ） were stmmal tumor. Adenocarcinoma appeared as focal wall thickening or diffuse infihralion with nmeosa enhancement （readerl , 75.9% of adenocareinoma; reader 2, 86.2% of adenocarcinoma）. Lymphoma most commonly manifested with nmhi-portion involved, confined to the mucosa and suhmueosa with wall thiekening of 〉 1cm, and presence of lymph nodes （reader 1 , 62.5% of lymphoma; reader 2, 37.5% of lymphoma）. And character of stromal tumor was large nmsses extend outside the gastric wall （ reader 1, 83.3% ; reader 2, 58.3% ）. Conclusion Certain imaging features may be helpful in differentiating gastric malignancies.