MSCT对胃黏液腺癌及非黏液腺癌的鉴别诊断及相应胃周淋巴转移评估

Differential Diagnosis of Mucinous Adenocarcinoma and Non-Mucinous Adenocarcinoma by MSTC and Assessment on Matastasis Corresponding Perigastric Lymph

目的探讨黏液胃癌(MGC)及非黏液胃癌(NGC)的CT影像特征及相应胃周淋巴结大小与转移的关系。方法回顾性分析经手术病理证实的42例黏液性胃癌CT资料,同时将从550例非黏液性胃癌中按年龄、性别配对的42例作为对照组,分析其病变的病灶大小,强化形式(分层/不分层)、强化程度(明显/不明显)及增厚的胃壁层,另外分析相应两组淋巴结大小及阳性转移率的异同,采用χ2检验,P<0.05表示差异有显著性。结果两组肿瘤原发位置及平均肿瘤大小,MGC与NGC无明显差异,90%的胃黏液腺癌病例胃壁明显增厚,主要表现为胃壁中层低密度,而非黏液腺癌胃壁增厚者占69%,主要为较高密度的内层或全胃壁增强扫描黏液癌增厚;黏液性胃癌最多见的强化形式是分层强(86%),90%的病例强化不明显;非黏液性胃癌为单层均匀强化(76%),62%的病例强化明显;黏液样胃癌淋巴结检出数量及阳性转移瘤均较非黏液样胃癌高,分别是268个,56%及142个,39%,差异有统计学意义(P<0.05)。1～5mm、6～9mm大小淋巴结率MGC与NGC两组分别33%、57%与22%、33%,差异有统计学意义(P<0.05)。≥10mm组淋巴检出率及阳性转移率MGC较NGC略高,差异无统计学意义。结论 MSCT能够准确地观察肿瘤增厚的胃壁层、强化形式及强化程度,有助于鉴别黏液性及非黏液性胃癌;黏液胃癌较非黏液胃癌淋巴结更容易淋巴转移,尤其对于术前诊断趋向MGC的病变,胃周淋巴结观察要仔细,不能忽略<10mm的淋巴结转移率。

Objective To investigate the MSCT characteristics of the mucus of gastric cancer（MGC） and non-mucinous gastric cancer（NGC）,as well as the relationship between the size of corresponding perigastric lymph nodes and the metastasis. Method CT data of 42 cases of MGC confirmed by surgery cases was retrospective analysis. 42 cases from the 550 cases of NGC matched on age and sex served as control group. The lesion size of lesions, enhancement pattern, strengthen degree and thickening of the gastric wall layer were analyzed in two groups. In addition, the size of corresponding lymph node and the similarities and differences of positive transfer rate were analyzed （P〈0.05）. Result Primary tumor location was not significantly different between the MGC and NGC. Stomach wall of 90% of MGC was significantly thickened, mainly manifested as middle-low-density stomach wall. While the stomach wall hickening of NGC was 69%, mainly manifested as higher density inner or thickening of mucinous carcinoma in stomach wall enhanced scans.Strong stratification had not significant strengthen.NGC was single-layer homogeneous enhancement,62% cases had obvious enhancement. The number of lymph node and positive metastase of MGC were higher than those of NGC（268 vs 142, 56% vs 39%）. The rates of 1~5mm and 6-9mm lymph node in MGC were 33%,57% ,while in NGC were 22% ,33% （P〈0.05）.In the group of ≥ 10mm the positive rate and metastasis rate were higher in MGC than those in NGC. The difference was not statistically significant. Conclusions MSTC was tumor thickening layer of the stomach wall, and strengthen the form and degree able to accurately observe the of enhancement, it is helpful to differentiate mucinous and NGC. Lymph node metastasis was easier in MGC than in NGC, especially for the preoperative diagnosis for the lesions tending to MGC. Perigastric lymph nodes should be observed carefully. Lymph node metastasis＇rate of less than 10mm can not be ignored.