64排螺旋CT三期增强扫描判断胃癌淋巴结转移的临床价值

Clinical Value of 64-slice Spiral Computed Tomography Triple-phase Enhanced Scanning in Evaluating Lymphatic Metastasis of Gastric Cancer

目的:探讨64排螺旋CT三期增强扫描判断胃癌淋巴结转移的指标参数及临床应用价值。方法:确诊为胃癌的患者,术前利用64排螺旋CT三期增强扫描检出胃周围淋巴结,与术后病理结果对照,从淋巴结短径、淋巴结CT值、淋巴结短长径比值、门静脉期与平扫期CT值之差等参数分析确定对判断淋巴结转移有价值的指标。结果:淋巴结门脉期CT值≥65 Hu、淋巴结短径≥6mm、淋巴结短长径比≥0.6、淋巴结门静脉期与平扫期CT值差≥35 Hu,以上4项中有两项符合要求判断淋巴结转移,敏感性为93.1%,特异性为50%,有三项符合要求判断淋巴结转移,敏感性为73.5%,特异性为75%。结论:64排螺旋CT三期增强扫描综合应用淋巴结的各项指标参数,可以对胃癌胃周围淋巴结是否转移作出比较可靠的判断,为术前制定合理的个性化治疗策略提供参考。

Objective： To study the parameters of 64-slice spiral computed tomography （CT） triple-phase enhanced scanning in evaluating lymphatic metastasis and its clinical application value. Methods： Patients diagnosed with gastric cancer were examined by 64-slice spiral CT before operation to measure gastric regional nodal involvement, and the results were compared with postoperative pathological findings. Valuable indicators on preoperative diagnosis of regional nodal involvement can be acquired by analyzing the parameters of lymphatic metastasis from the lymph node short diameter, lymph node CT value, lymph node short-to-long diameter ratio value, portal venous period, and flat sweep period of the differences of the CT value. Results： The lymph nodes portal venous period CT value I〉 65 Hu, lymph node short diameter ≥ 6 mm, lymph node short aspect ratio ≥0.6, portal venous period, and flat sweep period of the differences of the CT value ≥35Hu were valuable parameters. A diagnosis sensitivity of 93.1% and specificity of 50% determined lymphatic involvement if two indices meet the above requirements. Moreover, if three parameters meet the requirements to evaluate lymphatic metastasis, the sensitivity was 73.5% and specificity of 75%. Conclusion： The use of 64-slice spiral CT triple-phase enhanced scanning and synthesis of various parameters of lymph nodes could lead to better judgment of perigastric lymph node metastasis, which can provide reference for preoperative, reasonable, and personalized treatment strategies for gastric cancer.