胃造影动态容积CT三维重建技术的建立及应用

Establishment and application of stomach imaging and three-dimensional reconstruction with dynamic volume CT

目的 探讨胃造影动态容积CT三维重建技术在胃部疾病诊断和病情评估的临床应用价值.方法 结合320排容积CT具有“薄”（层厚0.5 mm）、“大”（人体纵轴16 cm）、“快”（单圈扫描0.35s）等特点,胃造影动态容积CT扫描后应用三维重建技术,具体分析胃及十二指肠球部的大小、形态、位置、壁厚薄、蠕动性、黏膜病变、动态增强表现及上腹部（包括肝、胆、胰、脾等脏器与周围血管等）的影像信息,并与纤维胃镜进行对比分析.共收集62例胃部疾病患者,包括胃肿瘤性病变29例、溃疡性病变6例、胃炎20例、胃憩室2例（均由手术病理或胃镜组织活检证实）,胃周血管病变5例（由血管造影证实）.结果 溃疡性病变及肿瘤性病变的诊断结果接近纤维胃镜的诊断结果,胃炎的诊断结果略差;肿瘤性病变能准确定位、定性、明确病灶转移及血供情况.结论 胃造影动态容积CT三维重建技术对胃及十二指肠疾病的准确定位及定性均有重要价值,尤其对肿瘤性病变术前的具体病情评估及手术方案拟定具有明显优势,为胃及十二指肠疾病的诊断提供了一个崭新的研究方法,值得临床推广应用.

Objective To study the clinical application value of stomach imaging and three-dimensional（3D） reconstruction with dynamic volume computed tomography（CT） in the diagnosis and evaluation of stomach diseases.Methods The 320-slice dynamic volume CT had the advantages of thin-slice （0.5mm）,long axis（16cm） and short scan time（0.35s）.After stomach imaging and dynamic volume CT scanning,3D reconstruction technique was applied.A concrete analysis of the size,shape,position,thickness,peristalsis,mucosal lesions and dynamic enhancement of gastric and duodenal bulb and upper abdomen（including the liver,gallbladder,pancreas,spleen and peripheral blood vessels）was given.And then they were compared with fiber gastroscope.A total of 62 cases of patients with stomach diseases were collected,including 29 cases of gastric tumors,6 cases of ulcerative lesions,20 cases of gastritis,2 cases of gastric diverticulum,which were confirmed by operational pathology or endoscopic biopsy,and 5 cases of perigastric vascular disease,which were confirmed by angiography.Results The diagnosis of dynamic volume CT in tumor and ulcerative lesions was close to that of the gastroscope.The diagnosis of dynamic volume CT in gastritis was slightly worse.Metastasis and blood supply of tumor lesions could be accurately investigated for quantitative and qualitative analysis.Conclusion Stomach imaging and 3D reconstruction with dynamic volume CT have an important value for quantitative and qualitative analysis of gastric and duodenal diseases.It is especially benefits for preoperative evaluation and operation plan of neoplastic lesions and provides a new research method for the diagnosis of gastric and duodenal diseases,which is worthy of clinical spreading.