64排螺旋CT增强鉴别对胃肠道上皮内瘤和早期癌的诊断效果

64-Slice Spiral CT Scan in the Differential Diagnosis of the Gastrointestinal Tract Intraepithelial Neoplasia and Early Cancer

目的评估64排螺旋CT增强鉴别对胃肠道上皮内瘤和早期癌的诊断效果。方法回顾性研究28例接受手术和CT鉴别的胃癌患者临床资料。CT鉴别结果均为肿瘤部位,胃壁的厚度,肿瘤的扩展,N1和N2淋巴结受累情况。比较螺旋CT鉴别和病理诊断结果。结果螺旋CT鉴别正确分期为20例(71.4%)。12例患者(42.9%)胃壁厚度<2 cm,其中10例(83.3%)浆膜受累,其余2例患者胃壁厚度分别为0.5和1.0 cm。16例(57.1%)患者胃壁厚度>2cm,且均有浆膜受累。CT评估胰腺侵入的敏感性、特异性和准确性分别为100.0%,73.9%和78.6%。螺旋CT评估浆膜受累有(无)邻近器官浸润的敏感性,特异性和准确性达到96.2%,100.0%和96.4%。螺旋CT评估病理淋巴结的敏感性、特异性和准确性分别为73.1%、50.0%和71.4%。结论螺旋CT是胃癌术前分期和早期胃癌诊断的优选技术。

Objective To assess the value of 64-slice spiral CT in the differential diagnosis of the gastrointestinal tract intraepithelial neoplasia and early cancer.Methods A retrospective study of clinical data of 28 patients with gastric cancer who underwent surgery and CT scans were conducted.CT scans of the tumor in all patients included stomach wall thickness,tumor ex-tension,N1 and N2 lymph node involvement,liver,peritoneum,lung metastasis.Comparison of spiral CT and pathological findings and results were made.Results Spiral CT staging was correct in 20 （71.4%）.12 cases （42.9%） of the stomach wall thick-ness 〈2 cm;10 cases（83.3%） had serosal involvement,and the remaining 2 cases with gastric wall thickness were 0.5 and 1.0 cm.16 cases （57.1%） with gastric wall thickness〉2 cm and all patients had serosal involvement.Sensitivity,specificity,and ac-curacy of CT assessment of pancreatic invasion were 100.0%,73.9%and 78.6%.Sensitivity,specificity,and accuracy of spiral CT assessment of serosal involvement with/without adjacent organ invasion were 96.2%,100.0%and 96.4%.Sensitivity,speci-ficity and accuracy of spiral CT in the evaluation of pathological lymph nodes were 71.4%,50.0% and 73.1%.Conclusion Spiral CT is the preferred technique in the diagnosis of preoperative staging of gastric cancer and early gastric cancer.