胃窗超声造影与超声双重造影对进展期胃癌术前T分期的比较

Comparison of preoperative T staging by oral contrast enhanced ultrasonography and double contrast enhanced ultrasonography in advanced gastric carcinoma

目的 评价胃窗超声造影与超声双重造影对进展期胃癌术前T分期的价值.方法 143例行手术治疗的胃癌患者术前行胃窗超声造影及超声双重造影检查,根据胃窗超声造影病灶二维图像质量分为病灶显示满意组和不满意组,并进行T分期,将超声检查结果与术后病理结果进行对照分析.结果 143例胃癌患者胃窗超声造影后均表现为局部胃壁不均匀增厚,其中病灶显示满意117例,病灶显示满意率为81.8%（117/143） 26例病灶二维图像显示轮廓模糊,病灶溃疡面充满高回声,后方伴声影,病灶浆膜面与周边组织界限不清.胃窗超声造影对胃癌术前T分期的准确率为74.1%（106/143）,其中病灶显示满意组的准确率为78.6%（92/117）,病灶显示不满意组的准确率为53.8%（14/26）.143例患者超声双重造影表现为病灶动脉期高增强,静脉期造影剂廓清早于周围正常组织,呈低增强.超声双重造影对胃癌T分期的准确率为86.7%（124/143）,其中病灶显示满意组的准确率为88.9%（104/117）,病灶显示不满意组的准确率为76.9%（20/26）.胃窗超声造影与超声双重造影的T分期准确率比较,差异有统计学意义（χ^2=9.031,P〈0.01）.结论 超声双重造影对进展期胃癌术前T分期的准确性显著高于胃窗超声造影.

Objective To compare the accuracy of preoperative T staging of gastric cancer by oral and intravenous contrast-enhanced gastric ultrasonography. Methods One hundred and forty three patients who had been diagnosed as gastric cancer by endoscopic biopsy and confirmed by pathology after operation were examined by oral and intravenous contrast-enhanced gastric ultrasonography, and they were divided into satisfied group and non-satisfied group according to the 2-D image quality of lesion. The results were compared with postoperative pathologic findings. Results All the patients with gastric cancer presented regional gastric wall thickening. Among them, 117 cases were clearly presented with good image quality. The remaining 26 cases were presented with vague profile, the ulcerative surface of lesion was filled with hyperechogenicity combined with rear shadow. The accuracy of oral contrast-enhanced ultrasonography in determining the T stage of gastric cancer was 74. 1 %. The accuracy in satisfied group and non-satisfied group was 78.6% and 53.8% , respectively. The enhancement pattern of 143 cases was showed as hyperenhancement during the arterial phase and hypoenhancement during the portal phase in DCUS. The accuracy of double contrast-enhanced ultrasongraphy in determining the T stage of gastric cancer was 86. 7% , but the accuracy in satisfied group and non-satisfied group was 88. 9% and 76.9% , respectively. There was a significant difference between the two methods （χ^2 = 9.031, P 〈 0.01）. Conclusion DCUS is more accurate than oral contrast-enhanced ultrasonography as a useful diagnostic method for preoperative T staging of gastric cancer.