气钡双重造影和多排螺旋CT对胃癌的诊断价值评价

The value of gastrointestinal double contrast and multislice spiral CT in the gastric carcinoma

目的评价胃肠气钡双重造影和多排螺旋CT对胃癌的诊断价值及多排螺旋CT对胃癌分期的准确度,探讨胃癌的影像学分期及其与手术病理检查结果的相关性。方法回顾性分析70例经病理检查证实胃癌患者的胃肠气钡双重造影检查及多排螺旋CT检查资料,观察二者图像上对病变的检出情况、病变部位、形态、病变CT增强后各期的特点、毗邻关系、淋巴结大小、远处转移等,多排螺旋CT检查与50例手术病理分期结果比较。结果气钡双重造影对胃癌的阳性检出率为71.4%(50/70),多排螺旋CT的阳性检出率为82.9%(58/70),两种方法检出率的差异具有统计学意义(χ2=4.083,P<0.05),多排螺旋CT的阳性检出率高于气钡双重造影。多排螺旋CT诊断Ⅰ、Ⅱ、Ⅲ、Ⅳ期胃癌的准确度分别为44.4%(4/9)、66.7%(4/6)、79.2%(19/24)、72.7%(8/11),多排螺旋CT分期的准确性为70.0%(35/50),经Kappa检验,Kappa值=0.550,多排螺旋CT分期与手术病理分期一致性较好。结论多排螺旋CT对胃癌的检出率高于气钡双重造影,多排螺旋CT对胃癌分期评估和治疗方案的选择具有重要的价值。

Objective To evaluate the significance of gastrointestinal double contrast （DC） and muhislice spiral CT （MSCT） in the diagnosis of gastric carcinoma, to discuss the accuracy of MSCT in preoperative staging of gastric carcinoma comparing with pathology. Methods 70 patients with histopathologically confirmed gastric carcinoma were performed with DC and MSCT examinations. The lesions on DC and MSCT were observed including location, shape, the features of enhanced CT in different phases, the relations with neighbours, the size of lymph node and distant metastasis. The results of MSCT were compared with pathological findings of 50 cases. Results The positive rates of DC and MSCT for gastric carcinoma were 71.4% （50/70） and 82.9% （58/70） respectively. The positive rate of MSCT was higher than DC, and the difference was statistically significant （X^2 = 4. 083, P 〈 0.05 ）. The diagnostic accuracy rate of MSCT for I , Ⅱ, m and IV stage gastric carcinoma was 44.4% （4/9） , 66.7% （4/6） , 79.2% （19/24） and 72.7 % （8/11 ） respectively, and the accuracy in staging of MSCT was 70.0% （35/50）. The staging with MSCT was quite posively correlated to that with surgery and pathology （Kappa = 0. 550 ）. Conclusions The detection rate of gastric carcinoma with MSCT is better than that with DC. MSCT has clinical significance for assessing the staging of gastric carcinoma and selecting therapeutic schedule.