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CT灌注成像在BorrmannⅡ型与Ⅲ型胃癌鉴别诊断中的价值 被引量:10

Value of CT perfusion imaging in differential diagnosis between Borrmann types Ⅱ and Ⅲ gastric cancer
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摘要 目的探讨CT灌注成像在BorrmannⅡ型与Ⅲ型胃癌鉴别诊断中的应用价值。方法回顾性分析2013年10月至2014年6月期间郑州大学第一附属医院收治的术前经胃镜证实为溃疡型胃癌并行CT灌注扫描的42例患者的临床资料,其中经术后病理证实为BorrmannⅡ型19例(BorrmannⅡ型组),BorrmannⅢ型23例(BorrmannⅢ型组)。采用日本东芝Aquilion One320排螺旋CT检查,选取常规扫描图像,在溃疡面最大的层面,沿着溃疡堤两侧内缘垂直于溃疡基底部胃壁作切线,将胃癌病灶组织分为近端(近贲门侧病灶)、溃疡部(溃疡及溃疡基底部)及远端(近胃窦侧病灶)3部分。在东芝4.7后处理工作站中选取灌注图像,采用Patlak—plot模式得出以下灌注指标:血流量(BF)、血容量(BV)、清除率(CL),并在Single-input Maximum模式下得出动脉血流量(AF)。比较不同分型两组胃癌病灶的灌注值指标,并采用受试者操作特征(ROC)曲线评估上述灌注指标对Borrmann分型的鉴别价值。结果两组溃疡处的AF、BV及BF的差异均无统计学意义(均P〉0.05),但BorrmannⅢ型组溃疡部CL值明显高于BorrmannⅡ型组[(7.17±2.41)L/s比(4.82±2.26)L/s,P=0.00]。两组病灶近端及远端的AF、BV、BF及CL值的差异均无统计学意义(均P〉0.05)。溃疡处CL值鉴别胃癌Borrmann分型所绘制的ROC曲线下面积为0.78,CL值鉴别诊断阈值为0.59L/s;当CL值〉0.59L/s时,诊断为Ⅲ型的灵敏度为0.70,特异度为0.80。结论CL值对BorrmannⅡ型与Ⅲ型胃癌的分型诊断有一定价值。 Objective To investigate the value of CT perfusion imaging in differential diagnosis between Borrmann types Ⅱ and Ⅲ gastric cancer. Methods All the patients were proven as ulcerated gastric cancer by preoperative gastroscopy and underwent CT perfusion scanning with Aquilion ONE 320 spiral CT from October 2013 to June 2014 in The First Affiliated Hospital of Zhengzhou University, including 19 patients as Borrmann type Ⅱ gastric cancer and 23 patients as Borrmann type m gastric cancer by pathology. Lesions were divided into three parts by two tangent lines perpendicular to the gastric wall of the ulcer edge, including proximal part (close to cardia), ulcer part and distal part (close to pylorus). All the perfusion images were analyzed in the Toshiba 4.7 post processing workstation. Blood flow (BF), blood volume (BV), and clearance (CL) were measured according to Patlak-plot mode, and arterial flow (AF) was measured according to Single-input maximum mode. Differences in all the parameters between Borrmann type Ⅱ and Ⅲ groups were analyzed. Receiver operating characteristic (ROC) curve was used to determine the threshold of perfusion parameters for differentiating Borrmann type H and m gastric cancer. Results There were no significant differences in AF, BV and BF of ulcer part between the two groups (all P 〉 0.05). While the CL of ulcer part in Borrmann type Ⅲ group was (7.17±2.41) L/s, which was significantly higher than (4.82± 2.26) L/s in Borrmann type Ⅱ group (P = 0.00). There were no significant differences for all the parameters at proximal part and distal part between the two types (all P 〉 0.05). According to the ROC curve, area under the curve of CL was 0.78. Taking 0.59 L/s as the threshold of CL value, the corresponding sensitivity and specificity for diagnosing Borrmann type Ⅲ were 70% and 80%, respectively. Conclusion The CL value has certain diagnostic value in differential diagnosis between Borrmann types Ⅱ and Ⅲ gastric cancer.
出处 《中华胃肠外科杂志》 CAS CSCD 北大核心 2016年第10期1149-1153,共5页 Chinese Journal of Gastrointestinal Surgery
基金 国家自然科学基金项目(81271573)
关键词 胃肿瘤 Borrmann分型 Ⅱ型 Ⅲ型 灌注参数 体层摄影术 X线计算机 鉴别诊断 Stomach neoplasms Borrmann type Perfusion parameters Tomography, X- ray computed Differential diagnosis
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