CT对浸润性胃癌的诊断

CT in Diagnosis of Infiltrative Gastric Carcinoma

目的分析浸润性胃癌的CT表现,提高其诊断水平。资料与方法回顾性分析经病理证实的30例浸润性胃癌患者的CT资料,行多平面重组(MPR)、最大密度投影(MIP)、CT仿真内镜(CTVE)等技术观察。结果 22例癌肿限于局部胃区,8例累及2个胃区以上;癌肿最厚处平均直径(30.10±1.34)mm。11例深、浅溃疡形成,19例胃腔缩窄。增厚的胃壁及肿块呈均匀强化9例,不均匀强化(含分层强化)21例。26例胃周淋巴结肿大,其中2例2个胃区淋巴结肿大。1例鳞癌;29例腺癌,其中高分化型5例,低分化型14例,未分化型9例,1例黏液腺癌,高分化腺癌和低分化腺癌/未分化腺癌的强化特点有显著差异(χ2=3.35,P<0.05)。结论多层螺旋CT平扫、三期增强扫描及MPR、MIP、CTVE的运用对浸润性胃癌的早期诊断具有重要的临床应用价值。

Purpose To analyze the CT features of the infiltrative gastric carcinoma,and to improve its diagnosis.Materials and Methods CT manifestations of 30 patients with infiltrative gastric carcinoma confirmed by pathology were analyzed retrospectively,and post-processing included multi-planner reformation（MPR）,maximum intensity projection（MIP） and CT virtual endoscopy（CTVE） were applied for further observation.Results Twenty-two lesions located in local gastric areas,8 cases involved more than two gastric areas;the maximum thickness of the infiliative gastric carcinoma was（30.10±1.34） mm.Eleven cases observed deep and shallow ulcer lesions,19 cases observed narrowed gastral cavity.Nine cases showed uniform enhancement of thickened gastric wall and tumor,21 cases showed uneven enhancement（including layered enhancement）.For 30 cases,26 cases had lymph node enlargement around stomach,2 cases involved 2 gastric areas.One case was squamous carcinoma;and 29 cases were adenocarcinoma,including 5 well-differentiated,14 poorly-differentiated,9 undifferentiated type and 1 myxoadenocarcinoma.The enhancement features showed statistical difference between well-differentiated adenocarcinoma and poorly-differentiated adenocarcinoma as well as undifferentiated adenocarcinoma（χ2=3.35,P＆lt;0.05）.Conclusion MSCT plain and enhanced scan and the application of MPR,MIP,CTVE are important for the early diagnosis of infiltrative gastric carcinoma.