多层螺旋CT在进展期胃癌术前TNM分期中的价值研究

Diagnostic evaluation of MDCT in preoperative TNM staging of advanced gastric cancer

目的探讨多层螺旋CT在进展期胃癌术前评估中的临床应用价值,为胃癌的合理治疗提供依据。方法采用低张水充盈技术,应用多层螺旋CT(MDCT)对119例接受胃癌手术的病人,按照临床检查及MDCT影像结果进行临床分期(CTNM),术后按照手术中探查和术后病理结果进行术后病理分期(PTNM)。比较每个病例术前临床分期与术后病理分期结果,分析术前各期的灵敏度、特异度、准确度、预测值等。结果 MDCT临床T分期与病理分期灵敏度:T2期62.16%,T3期84.85%,T4期37.50%。特异度:T2期85.37%,T3期60.15%,T4期97.09%。准确度:T2期78.15%,T3期75.63%,T4期89.08%。阳性预测值:T2期65.71%,T3期74.67%,T4期66.67%。阴性预测值:T2期83.33%,T3期77.27%,T4期90.91%。浆膜受侵突破的灵敏度85.37%,特异度62.16%,准确度78.15%。对淋巴结转移的灵敏度45.68%,特异度94.74%,准确度61.34%。结论 MDCT对胃癌浸润深度的准确性及病灶的检出率较高,尤其在浆膜是否突破方面价值较高,可作为目前进展期胃癌术前临床分期的首选检查。

Objective TO investigate the diagnostic evaluation of Multidetector row computed tomography（MDCT） of preoperative TNM staging of advanced gastric cancer and provide the basis for rational therapy of gastric cancer.Methods With hypotonia and water filling technique,MDCT examination was performed in 119 cases of gastric cancer diagnosed by surgery,according to the clinical examination and MDCT image,clinical staging（CTNM） were classified and compared respectively with the preoperative staging in accordance with the surgical tumor circumstance and pathological staging（PTNM）,the sensitivity,specificity,and accuracy of each clinical staging were calculated.Results The sensitivity of clinical staging of T2,T3 and T4 were 62.15%,84.85% and 37.5%,respectively.The specificity of clinical staging of T2,T3 and T4 were 85.37%,60.15% and 97.09%,respectively.The accuracy of clinical staging of T2,T3 and T4 were 78.15%,75.63% and 89.08%,respectively.The sensitivity,specificity and accuracy of penetrating serosa of gastric wall were 85.37%,62.16% and 78.15%,respectively.The sensitivity,specificity and accuracy of lymph node metastasis of advanced gastric cancer were 45.68%,94.74% and 61.34%,respectively.Conclusion MDCT can be recommended as the first optional methods to detect the stage of gastric cancer at present,especialy in detecting the gastric cancer penetrating wall and finding the primary tumor.