Borrmann Ⅳ型胃癌的多排螺旋CT特征及对临床病理的影响

MDCT features and clinicopathological correlation of Borrmann type Ⅳ gastric cancer

目的探讨Borrmann Ⅳ型胃癌的多排螺旋CT(multi-detector spiral computed tomography,MDCT)特征及对临床病理的影响。方法回顾性分析136例经手术病理证实的Borrmann Ⅳ型胃癌患者的MDCT,采用水作为阴性对比剂,分别获取24 s(动脉期)、60 s(静脉期)和120 s(平衡期)的CT图像。由两名放射科医生观察图像并分析病灶分层强化的特征,将强化程度分为4种类型(不强化、轻度强化、中度强化和明显强化),影像参数还包括病灶部位、长度及最大厚度、浸润深度及淋巴结转移等。结果 136例病例中有96例在增强动脉期呈现分层强化的模式(内层中度强化、外层轻度强化),123例在增强静脉期呈现分层强化的模式(内层中度-明显强化、外层轻度-中度强化)。从动脉期至平衡期,增厚的胃壁呈由内向外透壁性强化,并在静脉期达强化峰值。在增强各期CT值得测量中,内层(99.6±19.8)HU的平均CT值高于外层(63.1±15.2)HU,差异有统计学意义(P <0.01)。病理分析结果中,135/136例为腺癌(1例为未分化癌),肿瘤基质均为sci,浸润模式均为INFc。结论 Borrmann Ⅳ型胃癌在MDCT扫描中具有一定特点,倾向于呈现分层强化的模式;自动脉期至平衡期,增厚的胃壁呈由内向外透壁性强化,并在静脉期达强化峰值。

Objective To explore the MDCT characteristics and clinicopathological correlation ofBorrmann Ⅳ gastric cancer.MethodsA retrospective review of the MDCT findings were performed in a series of136 patients with histologically confirmed Borrmann Type Ⅳ gastric carcinoma. CT images were obtained 23 s(arterial phase),60 s(venous phase)and 120 s(equilibrium phase)after injection of a nonionic contrast material,with water used as a negative contrast material. Two radiologists reviewed the CT images and analyzed layers andenhancement patterns. The readers evaluated the enhancement degree(non,mild,moderate,or marked)andcalculated CT attenuation values by placing circular regions of interest(ROIs)within the largest level of the lesion.Other observations also include length and maximum thickness of tumor,depth of invasion,as well as lymphade-nopathy.ResultsAmong 136 cases,96 were double-layered in the arterial phase,with a moderately enhancedinner layer and a mildly enhanced outer layer. One hundred and twenty-three cases were also double-layered inthe venous phase,with a moderately-markedly enhanced inner layer and mildly to moderately enhance outer layer.From the arterial phase to the equilibrium phase,the thickened gastric wall was enhanced from the inner layer tothe outer layer. Then,degree of enhancement reached the peak in the venous phase. In each phase of enhancedCT,the average CT value of the inner layer(99.6 ± 19.8)HU was higher than that of the outer layer(63.1 ± 15.2)HU(P < 0.01). In the pathological analysis,135 cases were adenocarcinomas(One case was undifferentiated carcinoma).The stromal volume was sciand the infiltration patterns were INFc.ConclusionBorrmann type Ⅳ gastric cancertend to show a double-layered pattern in the arterial phase and a single-layered pattern in the delayed phase.