能谱CT多向调整多平面重组在术前评估胃癌T分期中的价值

Spectral CT Combined with Multi-direction Adjusting and Multi-Planar Reformation for the Pre-operative T Staging of Gastric Cancer

目的探讨能谱CT成像联合多向调整多平面重组(MPR)在术前评估胃癌T分期中的价值。方法搜集经术前病理确诊为胃癌并行腹部能谱CT扫描的患者65例,男49例,女16例,年龄22~84岁,中位年龄58.3岁;对常规混能及最佳单能量图像进行横轴位、冠状位、矢状位及多向调整MPR,后者以同层显示最大范围胃癌病变为佳;依据不同的重建图像进行T分期评估。结果术后病理证实T1期4例,T2期12例,T3期33例,T4期16例。常规混能轴位图像及最佳单能量轴位图像分别联合冠状位、矢状位、多向调整MPR对胃壁T分期的总的准确性分别为78.5%、81.5%、83.1%、87.7%;80.0%、84.6%、89.2%、92.3%;联合不同的重建方法在不同部位胃癌T分期诊断中的效能不同。结论能谱CT联合多种MPR进一步提高了胃癌T分期诊断的准确性。

Objective To explore the value of spectral CT imaging combined with multi-direction adjusting and multiplanar reformation( MPR) in the preoperative T-Staging evaluation of gastric cancer. Methods Sixty-five patients with gastric cancer confirmed by pathology before the operation underwent abdominal double-phase enhanced gemstone spectral imaging scanning with Spectral CT( 49 men,16 women; age range 22-84 years old with a median age of 58. 3 years old).The axial,coronal,sagittal and multi-direction adjusting and MPR was performed on the conventional k Vp and optimal monochromatic images. The multi-direction adjusting and MPR images which can display the maximum range of the gastric cancer on the same slice were better. The T-stages of the individual gastric cancer lesions were then determined according to the different reconstructed images. Results 4 cases,12 cases,33 cases,16 cases were diagnosed as T1,T2,T3,T4 staging respectively by the pathology examination after the operation. The overall accuracies of axial images; combined axial and coronal images; combined axial and sagittal images,combined axial and multi-direction adjusting; and MPR images on conventional k Vp images and the optimal monochromatic images for the evalution of the T-staging were 78. 5%,81. 5%,83.1%,87. 7%; 80. 0%,84. 6%,89. 2%,92. 3% respectively. The diagnostic efficiencies were different according to various kinds of the reformation images that were employed on the T-Stage evaluation of the different parts of the gastric cancer.Conclusion Spectral CT combined with multiple MPR images can further improve the accuracy of the T-Stage evaluation of gastric cancer.