低剂量低对比剂低张胃充气造影MSCT诊断胃肿瘤的临床研究

目的探讨低剂量低对比剂低张胃充气造影多层螺旋CT(MSCT)诊断胃肿瘤的临床应用价值。方法选取2015年1月至2016年1月在我院进行胃镜检查拟患有胃肿瘤的患者90例,所有患者均进行MSCT检查,将患者按就医顺序随机分为三组,每组30例。对照组采用固定毫安的方式进行检查,实验组使用低剂量低对比剂低张胃充气的方式进行检查,观察组同样使用该方法但在噪声指数中标准差方面有所不同,其中实验组SD为12,观察组为15,造影剂均使用碘海醇。对三组患者的MSCT图像质量和剂量加权指数降低率进行比较。结果对照组与实验组在胃壁情况、脏器间情况及脏器显示方面图像均较为清晰,而观察组在胃壁情况、脏器间情况及脏器显示方面,图像质量均相对较差,但并未影响定性诊断;对照组与实验组图像质量评分为10分的比例比较,差异无统计学意义(P>0.05),二者与观察组相比较,差异具有统计学意义(P<0.05);三组剂量加权指数降低率分别为12.7%、35.7%、78.6%,组间比较,差异均具有统计学意义(P<0.05)。结论在不影响图像质量的情况下,尽量减少对比剂及使用智能毫安调节的方式进行MSCT能减少人体受到的辐射量,提高安全性,同时有效减少患者的经济负担。低剂量低对比剂低张胃充气可有效提高胃肿瘤的MSCT诊断效果,具有重要的临床推广价值。

胃癌腹膜腔种植转移的MSCT表现

目的:探讨胃癌腹膜腔种植转移的多层螺旋CT影像特征。方法:收集经手术探查和腹膜腔穿刺证实为腹膜腔转移的胃癌患者的腹部CT图像。分析CT图像上肠壁增厚部位和增强方式,网膜、系膜有无增厚、结节以及增强方式,有无腹水以及分布部位,肾盂输尿管积水以及有肝脾转移等。对接受2次以上CT复查者,观察CT表现的变化。结果:胃癌腹膜腔转移104例,男67例,女37例。73例显示结肠肠壁增厚,其中71例增厚肠壁有强化,31例呈层状强化。42例显示直肠肠壁增厚,其中41例强化,25例显示层状强化。55例发现腹膜腔积液。3例显示网膜或系膜增厚,14例显示网膜或系膜结节影。肾盂输尿管积水27例,胸腔积液6例,腹腔肿块2例。结论:胃癌腹膜腔种植转移的CT表现为大肠壁增厚和肠壁环形强化、腹膜腔积液与肾盂输尿管积水。腹膜增厚、网膜结节和腹腔肿块发生率低。

MSCT对胃癌术前TN分期的临床应用价值

目的探讨MSCT检查在胃癌TN分期的临床应用价值。方法回顾性分析我院2011年1月～2014年12月经病理或手术证实的50例胃癌患者的MSCT平扫及双期增强扫描资料，并与术后病理结果对照，评价MSCT在胃癌TN分期的临床应用价值。结果MSCT胃癌T分期诊断的总体准确率为74％（37／50），其中对T1、T2、T3和T4期判断的特异度分别为75．0％、73．3％、71．4％、80．0％，敏感度分别为75．0％、68．5Voo、75．0％、80．0Voo。MSCT胃癌N分期诊断的总体准确率为71．7％（33／46），其中对NO、N1、N2期判断的特异度分别为73．3％、71．4％、70．0％，敏感度分别为73．3％、68．2％、77．8％。结论MSCT对胃癌术前TN分期的诊断具有较高准确性，可以为临床选择治疗方案、评估预后提供重要的参考价值。

MSCT用于胃癌淋巴结转移早期诊断的临床价值

目的探讨多层螺旋CT(MSCT)用于胃癌淋巴结转移早期诊断的临床价值。方法选择2016年1月至2020年1月于平煤神马医疗集团总医院行远端胃癌根治术的80例患者作为研究对象,以患者术后胃标本及淋巴结病理检查结果为金标准,分析MSCT平扫及增强对胃癌淋巴结转移、N分期的判断价值。结果以术后胃癌病理学诊断为金标准,80例胃癌患者中52例(65.00%)有淋巴结转移,其中,术前MSCT增强诊断胃癌淋巴结转移的准确度、敏感度、阳性预测值、阴性预测值为86.25%、88.46%、90.20%、79.31%,明显高于MSCT平扫检查的61.25%、61.54%、74.42%、45.92%,差异均有统计学意义(P<0.05);以术后淋巴结病理诊断为金标准,80例胃癌患者中N0、N1、N2、N3期患者分别为14例、33例、23例、10例,其中MSCT平扫对胃癌N0~N1期及N2~N3期的分期诊断准确度分别为51.06%、72.73%,明显低于MSCT增强的78.72%、96.97%,差异均有统计学意义(P<0.05),其中MSCT增强对N2~N3期的诊断准确率为96.97%,明显高于N0~N1期的72.73%,差异有统计学意义(P<0.05)。结论MSCT增强对胃癌淋巴结转移的准确度较高,对晚期胃癌的适用性更强,可为手术方式的选择提供参考。

A preliminary study on correlations of triple-phase multi-slice CT scan with histological differentiation and intratumoral microvascular/lymphatic invasion in gastric cancer

Background Many studies have shown that cancer cell differentiation and microvascular invasion play a principle role in cancer progression and metastasis, and non-invasive imaging techniques such as CT, MRI and US assessing the differentiation and the surgical resectibility and the prognosis of cancers are now of great importance. This study aimed to explore the correlation of triple-phase multi-slice CT scan with the histological differentiation and intratumor microvascular/lymphatic invasion of progressive gastric cancer.Methods The present study included 64 patients with gastric cancer, all of whom underwent routinal and dual-phase contrast enhancement multi-slice CT examinations of the upper abdomen before surgery. The post-operative specimens were used for determination of histological differentiation, cancer cell invasion of intratumoral microvascular/lyrnphatic vessel identified by CD34 and D2-40 expression. Correlations between contrast enhancement ratio （CER） of triple-phase multi-slice CT scan in gastric cancer and histological differentiation as well as intraturnoral microvascular/lymphatic invasion were compared and analyzed.Results There was a significant correlation between CER of triple-phase CT scan in gastric cancer and tumor histological differentiation （P〈0.05）. CER of the arterial phase in gastric cancer with intratumoral microvascular invasion was significantly higher than that without invasion （0.61±0.28 vs. 0.46±0.14, P 〈0.05）; CER of the arterial-parenchymal phase was significantly lower in gastric cancer with intratumoral microvascular invasion than that without invasion （1.81±0.39 vs. 2.28±0.80, P〈0.05）. However, CER of the parenchymal phase in gastric cancer with intratumoral lymphatic invasion was significantly higher than that without invasion （1.25±0.57 vs. 1.00±0.35, P〈0.05）.Conclusions CER of triple-phase multi-slice CT scan in gastric cancer is closely correlated with intratumoral microvascular and lymphatic invasion, and also could be used as a marker for histological differentiation.

Multi-slice CT contrast-enhanced presentations of advanced gastric cancer： associations with histo-differentiation and expression of p53 and P-glycoprotein

Background This study aimed to investigate multi-slice CT contrast-enhanced presentation of gastric cancer and its correlation with histo-differentiation and p53 and P-glycoprotein （P-gp） expression. Methods Sixty-six patients with gastric cancer in the present study underwent a multi-slice CT preoperative routine and dual-phase contrast-enhanced examination of the upper abdomen; postoperative specimens were used to determine histo-differentiation and the expression of p53 and P-gp. The correlation of multi-slice CT contrast-enhanced presentation with histo-differentiation and expression of p53 and P-gp was analyzed. Results The dual-phase contrast-enhanced ratio （CER） was not correlated with the histo-differentiation of gastric cancer （P 〉0.05）. Positive expression of p53 and P-gp was significantly higher in the cases of layered or heterogeneous enhancement than in the cases of homogenous enhancement （P 〈0.05）. Positive expression of p53 was also correlated with the arterial phase CER, tumor size and lymph node metastasis （P 〈0.05）, but not with infiltration thickness of the gastric wall, nor was it correlated with the portal phase CER （P 〉0.05）. Positive expression of P-gp was only correlated with the portal phase CER （P=0.005）. Conclusions Differently enhanced pattern and CER of the arterial and portal phase in gastric cancer correlate with its different histo-differentiation and expression of p53 and P-gp respectively. In addition, tumor size and lymph node metastasis of gastric cancer relate to the expression of p53.

多层螺旋CT在胃癌术前诊断中应用的研究进展

多层螺旋CT(multi-slice spiral CT,MSCT)对胃癌检查的成像技术日益成熟,多期增强扫描结合多平面重组(multi planner rerformation,MPR)后处理技术能充分显示胃壁多层结构,可以观察到胃壁结构的异常变化,有利于检出胃癌。通过观察胃癌侵犯胃壁深度、淋巴结转移和远处转移情况,对胃癌进行术前TNM分期的评估已成为近年来临床研究的热点,该文就MSCT在胃癌术前诊断中应用的研究进展作一综述。

应用多层螺旋CT对胃癌进行诊断的临床价值分析

目的:探讨应用多层螺旋CT进行胃癌诊断的临床价值。材料与方法:对我院收治经胃镜证实为胃癌患者80例行多层螺旋CT检查,分析其影像学表现,诊断病情及分期,并同手术及病理结果进行对照。结果:80例患者经多层螺旋CT扫描全部检出,检出率为100%,患者均未进展型胃癌,对胃癌大体分型总准确率为85%,TNM的分期总准确率为81.2%。结论:多层螺旋CT检查能够准确对胃癌进行诊断及分期,并为制定合理治疗方案和预后提供重要支持,具有重要临床价值。

多层螺旋CT在胃癌诊断及术前分期中的价值

目的分析多层螺旋CT(MSCT)在胃癌诊断及术前分期中的价值。方法选取2013年1月至2018年1月我院收治的40例胃癌患者为研究对象,所有患者均术前1周内空腹或禁食4 h后行MSCT检查并进行分期,术后将病理与MSCT结果对比并分析检查结果。结果 MSCT诊断淋巴结转移(N分期)的准确率为80.00%,其中N_0 77.78%,N_1 79.17%,N_2 83.33%,N_3 100.00%;诊断胃癌浸润深度(T分期)的准确率为67.50%,其中T_1 100.00%,T_2 60.00%,T_3 72.22%,T_4 60.00%;诊断胃癌远处转移(M分期)的准确率为95.00%,其中M_0 80.00%,M_1 97.14%。结论 MSCT在胃癌诊断及术前分期诊断中具有较大的临床应用价值,值得进一步推广。

多层螺旋CT对胃癌及肿瘤血供的应用价值

目的探讨多层螺旋CT(MSCT)在胃癌患者术前诊断、肿瘤血供显像中的应用价值。方法选取我院经手术病理检查确诊的胃癌患者62例,在术前对其进行MSCT及血管造影检查。分析MSCT的分期诊断准确率及对胃癌血供的显示情况。结果MSCT与手术病理检查对胃癌的确诊率及分期诊断准确率无显著差异(P>0.05);MSCT与血管造影对于胃癌肿瘤供血动脉的显示率无显著差异(P>0.05)。位于胃体、贲门、胃窦的肿瘤组织的CT值均显著高于正常组织(P<0.05)。结论 MSCT可准确对胃癌进行分期诊断,并能较好地反映胃癌血供情况,具有重要应用价值。