进展期与早期胃癌螺旋CT三期增强的诊断价值

Diagnostic value of triphasic incremental helical CT in early and progressive gastric carcinoma

目的 探讨胃癌的螺旋CT强化特征 ,评价口服水螺旋CT三期扫描对胃癌术前分期的诊断价值。方法 对 46例胃癌患者实施胃气钡双对比造影及口服水螺旋CT三期增强扫描 ,并与术后病理对照。结果 (1) 4 6例胃癌中 ,18例正常胃壁呈单层结构 ,2 8例正常胃壁在动脉期或门静脉期表现为 2～ 3层结构。 (2 ) 2例早期胃癌在动脉期及门静脉期明显强化 ,在平衡期强化程度明显下降。 44例进展期胃癌中 ,32例以门静脉期强化程度为著 ,与动脉期比较有显著性差异 (t =4 2 2 6 ,P <0 0 5 )。 (3)螺旋CT三期增强扫描对胃癌TNM分期的准确性为 81 0 %。结论 不同类型的胃癌具有不同的强化特征。螺旋CT三期增强扫描对胃癌术前分期的准确性明显高于普通CT。

Objective To investigate helical CT enhancement characteristics of gastric carcinoma, and the diagnostic value and preoperative staging of gastric carcinoma with triphasic incremental helical CT of the stomach with water-filling method.Methods Both double-contrast barium examination and triphasic incremental helical CT of the stomach with water-filling method were performed in 46 patients with gastric carcinoma.Results (1) Among these patients, normal gastric wall exhibited one layered structure in 18 patients, two or three layered structure in 28 patients in the arterial and portal venous phase. (2) Two cases of early stomach cancer showed marked enhancement in the arterial and portal venous phase and obvious attenuation of enhancement in the equilibrium phase.On the contrary, 32 of the 44 advanced gastric carcinoma was showed marked enhancement in the venous phase compared with the arterial phase ( t=4.226, P<0.05). (3) The total accuracy of triphasic incremental helical CT in determining TNM-staging was 81.0%.Conclusion Different types of gastric carcinoma have different enhancement features. Triphases incremental helical CT is more accurate than convertional CT in the preoperative staging of gastric carcinoma.