Evaluation of recurrence in gastric carcinoma: Comparison of contrast-enhanced computed tomography and positron emission tomography/computed tomography

AIM To compare the value of contrast-enhanced abdominal computed tomography(CT) and fluorodeoxyglucose(FDG) positron emission tomography/computed tomography(PET/CT) for detecting gastric carcinoma recurrence.METHODS We retrospectively examined data from 2475 patients who underwent both contrast-enhanced abdominal CT and FDG PET/CT for the surveillance of gastric carcinoma curative resection. Patients had an interval of less than 1 mo between their CT and PET/CT scans. Sixty patients who had recurrence were enrolled. Among 1896 patients who did not have recurrence, 60 were selected by simple random sampling. All CT and PET/CT images were reviewed retrospectively by two reviewers blinded to all clinical and pathologic information except curative resection due to gastric carcinoma. RESULTS The pathological stage of the recurrence group was statistically significantly higher than that of the control group(P < 0.001). In the 60 patients who had recurrence, there were 79 recurrent lesions. Fortyfour patients had only one location of recurrence, 13 patients had two locations, and 3 patients had three. In the detection of patient-based overall recurrence, no statistically significant differences existed between the two modalities(P = 0.096). However, for peritoneal carcinomatosis, CT had a statistically significantly higher sensitivity compared to PET/CT(96% vs 50%, P = 0.001). Adenocarcinoma was the most common type of gastric carcinoma. On the pathology-based analysis, CT also had a statistically significantly higher sensitivity compared to PET/CT(98% vs 80%, P = 0.035).CONCLUSION Contrast-enhanced CT was superior to PET/CT in the detection of peritoneal carcinomatosis and pathologic type of adenocarcinoma.

Can visceral fat parameters based on computed tomography be used to predict occult peritoneal metastasis in gastric cancer?

BACKGROUND The preoperative prediction of peritoneal metastasis(PM)in gastric cancer would prevent unnecessary surgery and promptly indicate an appropriate treatment plan.AIM To explore the predictive value of visceral fat(VF)parameters obtained from preoperative computed tomography(CT)images for occult PM and to develop an individualized model for predicting occult PM in patients with gastric carcinoma(GC).METHODS A total of 128 confirmed GC cases(84 male and 44 female patients)that underwent CT scans were analyzed and categorized into PM-positive(n=43)and PM-negative(n=85)groups.The clinical characteristics and VF parameters of two regions of interest(ROIs)were collected.Univariate and stratified analyses based on VF volume were performed to screen for predictive characteristics for occult PM.Prediction models with and without VF parameters were established by multivariable logistic regression analysis.RESULTS The mean attenuations of VF_(ROI 1)and VF_(ROI 2)varied significantly between the PM-positive and PMnegative groups(P=0.044 and 0.001,respectively).The areas under the receiver operating characteristic curves(AUCs)of VF_(ROI 1)and VF_(ROI 2)were 0.599 and 0.657,respectively.The mean attenuation of VF_(ROI 2)was included in the final prediction combined model,but not an independent risk factor of PM(P=0.068).No significant difference was observed between the models with and without mean attenuation of VF(AUC:0.749 vs 0.730,P=0.339).CONCLUSION The mean attenuation of VF is a potential auxiliary parameter for predicting occult PM in patients with GC.

Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach

Inflammatory fibroid polyp(IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography(CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.

^(18)F-Fluorodeoxyglucose positron emission tomography/computed tomography comparison of gastric lymphoma and gastric carcinoma

AIM To compare ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT) features in gastric lymphoma and gastric carcinoma.METHODS Patients with newly diagnosed gastric lymphoma or gastric carcinoma who underwent ^(18)F-FDG PET/CT prior to treatment were included in this study. We reviewed and analyzed the PET/CT features of gastric wall lesions,including FDG avidity,pattern(focal/diffuse),and intensity [maximal standard uptake value:(SUVmax)]. The correlation of SUVmax with gastricclinicopathological variables was investigated by χ~2 test,and receiver-operating characteristic(ROC) curve analysis was performed to determine the differential diagnostic value of SUVmax-associated parameters in gastric lymphoma and gastric carcinoma. RESULTS Fifty-two patients with gastric lymphoma and 73 with gastric carcinoma were included in this study. Abnormal gastric FDG accumulation was found in 49 patients(94.23%) with gastric lymphoma and 65 patients(89.04%) with gastric carcinoma. Gastric lymphoma patients predominantly presented with type Ⅰ and type Ⅱ lesions,whereas gastric carcinoma patients mainly had type Ⅲ lesions. The SUVmax(13.39 ± 9.24 vs 8.35 ± 5.80,P < 0.001) and SUVmax/THKmax(maximal thickness)(7.96 ± 4.02 vs 4.88 ± 3.32,P < 0.001) were both higher in patients with gastric lymphoma compared with gastric carcinoma. ROC curve analysis suggested a better performance of SUVmax/THKmax in the evaluation of gastric lesions between gastric lymphoma and gastric carcinoma in comparison with that of SUVmax alone.CONCLUSION PET/CT features differ between gastric lymphoma and carcinoma,which can improve PET/CT evaluation of gastric wall lesions and help differentiate gastric lymphoma from gastric carcinoma.

Rim^(18)F-fluorodeoxyglucose uptake of hepatic cavernous hemangioma on positron emission tomography/computed tomography:A case report

BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare.Therefore,clinicians should pay close attention to patients with hepatic mass.CASE SUMMARY A 54-year-old woman with a 4-wk history of daily fevers was admitted to our hospital.A whole body^(18)-Fluordesoxyglucose(PET-FDG)positron emission tomography/computed tomography(PET/CT)was performed to elucidate the source of the fever.However,whole body^(18)-FDG PET/CT raised the suspicion of a malignant lesion because of peripheral FDG accumulation(SUVmax 3.5 g/mL)higher than that of the normal liver parenchyma(SUVmax 1.6 g/mL)surrounding a hypoactive area,and no other abnormalities were showed.Subsequently,the patient underwent liver mass resection.Histopathology showed a hepatic cavernous hemangioma with fatty infiltration around the lesion.The fever disappeared four days after surgery and the patient did not present any complications during follow-up.CONCLUSION Fatty infiltration in the peripheral parts of hepatic cavernous hemangioma may lead to subacute inflammation which further activate the Kupffer cells.This may cause prolonged fever and peripheral rim FDG accumulation on PET/CT.

Small cell lung carcinoma metastatic to the stomach: Commonly overlooked, limited treatment options

Small cell lung carcinoma metastatic to the stomach,whether synchronous or metachronous,is a rare phenomenon accounting for<0.5%of lung cancers.Hence it can be overlooked by clinicians resulting in delayed diagnosis.This manuscript comments on Yang et al’s article which reported 3 such cases.The main diagnostic features are based on routine morphology comprised of small cells with hyperchromatic nuclei,scant cytoplasm,brisk mitoses and necrosis.This can be supplemented by immunohistochemistry demonstrating positivity for cytokeratin,thyroid transcription factor-1 and neuroendocrine markers as well as a high Ki-67 labelling index.Imaging modalities such as positron emission tomography/contrast computed tomography help to confirm lung origin and rule out the possibility of extra-pulmonary small cell carcinoma.The predominant mechanism of spread is most likely hematogeneous.Prognosis is generally poor since this represents stage 4 disease but survival can be improved by chemo/ra-diotherapy and palliative surgery in select cases.Though outcomes have not changed much in the last several decades,the recent Food and Drug Adminis-tration approval of immune checkpoint inhibitors was a significant milestone as was the delineation of small cell lung carcinoma molecular subtypes.Liquid biopsies are increasingly being used for biomarker studies in clinical trials to assess treatment response and prognosis.

增强CT鉴别胃神经内分泌癌与胃腺癌的价值探讨

目的探讨增强CT在胃神经内分泌癌(gastric neuroendocrine carcinoma,GNEC)与胃腺癌(gastric adenocarcinoma,GADC)鉴别诊断中的价值。方法回顾性纳入四川省人民医院经病理证实为GNEC和GADC的患者各59例,对两组病例的临床指标及CT影像学特征进行分析比较,将有统计学差异的影像学特征及临床指标作为独立预测因子,运用ROC曲线分析单独及联合运用各独立预测因子对两类肿瘤鉴别诊断的效能。结果GNEC与GADC两组病例中,临床指标CA19-9差异有统计学意义(P<0.05),CT影像学特征包括肿瘤发生部位、肿瘤长径、有无坏死囊变、肿瘤边缘清晰或模糊、胃黏膜是否完整及胃周有无阳性淋巴结显示差异有统计学意义(P<0.05);ROC曲线分析结果显示,单独应用具有统计学差异的各项CT影像特征和CA19-9作为独立预测因子鉴别GNEC和GADC的AUC值分别为0.612、0.647、0.636、0.619、0.585、0.593、0.424,各独立预测因子联合运用的AUC值为0.814,灵敏度和特异度均有提升(P<0.05)。结论GNEC与GADC的增强CT影像学特征具有一定差异性,综合分析这些影像特征,同时结合CA19-9等临床指标有助于提高二者术前无创性鉴别诊断的准确性。

浸润型胃癌的CT表现特点与临床应用价值

目的 观察和分析浸润型胃癌的CT表现特点 ,评价CT在浸润型胃癌诊断中的价值。资料与方法 32例浸润型胃癌患者接受了CT检查 ,经胃镜和 /或外科手术及病理证实。所有病例经动态增强或螺旋CT多期扫描检查。结果 32例CT检出病变 31例 ,2 9例得到正确诊断。根据CT主要表现 ,浸润型胃癌分为 4型 :胃壁局限性增厚型 4例 ;弥漫性增厚型 5例 ;局限性胃壁增厚合并胃腔缩窄型 10例 ;弥漫性胃壁增厚合并胃腔缩窄型 12例。强化方式为 :病灶在动脉期呈不均匀轻度强化 (8/ 2 3)或明显强化 (9/ 2 3) ;门脉期渐进性显著强化 (2 5 / 31) ;平衡期病灶延迟显著强化 (17/ 2 3)。其他表现 ,腹水 8例 ,网膜侵犯和腹腔种植 11例。结论 使用服水低张 ,螺旋CT多期或动态增强扫描技术 ,CT在弥漫浸润型胃癌诊断和鉴别诊断方面具有很高的准确性 ,有较高的临床应用价值。

螺旋CT成像技术在胃癌CT分期及术前评估中的价值

目的 通过对本组胃癌病人进行螺旋CT扫描的前瞻性研究 ,旨在提高螺旋CT在胃癌CT分期和术前评估的准确性。方法 通过对 48例胃癌病人SCT的轴位图像和重建的MPR及SSD图像的观察分析 ,以Lauren的组织临床分类法为基础结合中国肿瘤协会对胃肿瘤的最新分期方法按TNM对各病例进行分期及术前评估。结果 所有病人的肿瘤诊断符合率为 10 0 % ,CT分期的准确性为 85 .42 % ,术前评估的准确性为 95 .0 0 %。结论 以Lauren的组织临床分类法为基础 ,SCT可以比较准确地对胃癌进行TNM分期及术前评估 ,为临床治疗提供有价值的信息。

胃癌的螺旋CT征象与MMP-9及Cath-D蛋白表达的关系

目的:探讨胃癌螺旋CT征象与基质金属蛋白酶-9(MMP-9)及组织蛋白酶D(Cath-D)蛋白表达的关系。方法:对52例胃癌患者行螺旋CT平扫及三期动态增强扫描。采用免疫组化SP法检测术后肿瘤组织和正常胃黏膜标本中MMP-9及Cath-D的蛋白表达,分析胃癌组织中MMP-9和Cath-D蛋白的表达与胃癌螺旋CT征象(有无淋巴结转移、Lauren分型及肿块大小)间关系及胃癌组织中MMP-9和Cath-D表达的关联性。结果:胃癌组织中MMP-9和Cath-D蛋白的阳性表达率明显高于正常胃黏膜组织(χ2分别为55.120、53.626,P均<0.001);胃癌组织中有淋巴结转移组MMP-9及Cath-D蛋白的阳性表达率高于无转移组(χ2MMP-9=8.341,P=0.004;χ2Cath-D=7.338,P=0.007);弥漫型胃癌组织中MMP-9及Cath-D蛋白的阳性表达率高于肠型,差异有统计学意义(χ2分别为4.312、6.175,P<0.05)。胃癌组织中Cath-D和MMP-9蛋白的表达有关联性(χ2=13.874,rP=0.496,P<0.05)。结论:MMP-9及Cath-D的高表达与胃癌螺旋CT征象上的Lauren分型和淋巴结转移有关。胃癌中组织MMP-9高表达与Cath-D高表达具有一致性,两者在胃癌的发展中可能起协同作用。

多层螺旋CT与数字胃肠对溃疡型胃癌的对照研究

目的 :评价多层螺旋CT(MSCT)与数字胃肠对溃疡型胃癌的诊断价值及影响因素。方法 :经手术病理证实的溃疡型胃癌 34例 ,手术前 1周分别行MSCT和数字胃肠检查。所有MSCT图像 (包括轴位、CTVG、SSD、Raysum)和数字胃肠图像 (经后处理的多相位图像 )分别由 2位胃肠组放射医师实行双盲阅片 ,阅片结果分别与手术标本及病理比较。结果 :34例患者的 38个溃疡 ,MSCT检出 35个 ,数字胃肠检出 37个 ;MSCT定位正确 35个 ,数字胃肠定位正确 37个 ;MSCT定性正确 35个 ,数字胃肠定性正确 36个。对 34个进展期癌的BorrmannⅡ、Ⅲ型分型 ,MSCT正确 31个 ,数字胃肠正确 2 2个。结论 :在溃疡型胃癌的检出、定位、定性方面 ,MSCT与数字胃肠无显著性差异 ,在BorrmannⅡ、Ⅲ型分型方面 。

多层螺旋CT术前初步评估胃癌分化类型的应用

目的探讨多层螺旋CT(MSCT)术前对胃癌病理分化类型进行初步评估的可行性。方法79例经胃镜诊断为胃癌并经手术证实的患者在术前进行MSCT平扫及双期增强(延迟时间为20s和70s)扫描。分析病灶生长方式、厚度及病变胃壁三期扫描CT值与病理分化类型间的关系。结果病变胃壁厚度及其生长方式均与病理分化类型相关。增强扫描时黏液癌强化较非黏液癌明显(P<0.01),而在非黏液癌中,低分化腺癌强化又较高分化腺癌明显(P<0.01)。结论利用MSCT可以在术前初步判断胃癌的病理分化类型。

螺旋CT诊断胃癌淋巴结转移的价值

目的:评价螺旋CT在胃癌淋巴结转移中的诊断价值。方法:对59例进展期胃癌患者于手术前1周内行螺旋CT平扫及三期动态增强扫描,对照病理结果,分析其CT征象。结果:①螺旋CT诊断胃癌淋巴结转移的准确率为84.75%(50/59),敏感性为92.31%(36/39),特异性达70.00%(14/20)。②胃癌淋巴结螺旋CT呈融合型、强化密度差值≥80Hu、不均匀强化及直径≥9mm者,病理转移的阳性率较高(χ2=14.12、37.10、7.00和23.72,P均<0.05)。结论:螺旋CT可较准确地检出胃癌转移淋巴结。

进展期胃癌与胃淋巴瘤的CT鉴别诊断及其判别模型的初步建立

目的:探讨CT在进展期胃癌(AGC)与胃淋巴瘤(GL)鉴别诊断中的价值,初步建立AGC与GL的判别模型。方法:回顾性分析经病理证实的50例AGC及23例GL患者的CT资料,总结AGC与GL的CT鉴别诊断要点,并采用逐步判别分析及分批筛选变量的方法,初步建立两者的CT判别模型。结果:①AGC最常累及胃窦,GL最常累及胃体及胃窦;累及多部位在两组间差异无统计学意义(P=0.193)。②弥漫性胃壁增厚和节段性胃壁增厚在两组间的发生率差异无统计学意义,局限性胃壁增厚多见于AGC患者,两组间差异有统计学意义(P=0.036)。③GL组胃壁厚度大于AGC组,两组间差异有统计学意义(P=0.001)。胃壁厚度鉴别AGC与GL的ROC曲线下面积为0.754(P=0.001),以14.5 mm为阈值鉴别诊断AGC与GL的敏感度和特异度分别为82.6%、56.0%,Youdern指数为0.386。④形态固定、胃腔局限性狭窄多见于AGC组,两组间差异有统计学意义(P=0.008)。⑤AGC组多表现为明显强化,GL组多表现为轻度/中度强化,两组间差异有统计学意义(P=0.000);AGC组多见不均匀强化,GL组多见均匀强化,两组间差异有统计学意义(P=0.004)。⑥AGC组多见白线征,GL组多见胃黏膜面细线样强化,两组间差异均有统计学意义(P值均=0.000)。⑦AGC组多见胃浆膜面脂肪间隙模糊,GL组多见浆膜面脂肪间隙清晰,两组间差异有统计学意义(P=0.000)。⑧AGC组与GL组均可见腹腔内淋巴结异常,腹主动脉下部旁淋巴结异常GL组相对多见于AGC组,但差异无统计学意义(P=0.074);淋巴结坏死只见于AGC患者(12%),GL患者未发现淋巴结坏死。采用逐步判别分析法(分批筛选)筛选出胃壁厚度、胃腔形态、强化程度、黏膜面细线样强化等4个最有效的指标,初步建立AGC与GL的CT判别模型,交互验证法验证结果显示判别函数对AGC与GL的总体正确判别率为91.8%。结论:多种CT征象在AGC与GL的鉴别诊断中具有重要价值,经逐步判别分析法(分批筛选)初步建立的AGC与GL的CT判别模型,具有临床实用价值。

CT在胃癌诊断中的作用

目的：综合评价ＣＴ在胃癌诊断中的作用。材料与方法：１９８９年１月～１９９４年４月，共２６９例胃异常病变患者接受了ＣＴ检查，肿瘤性病变者２３８例，其中胃癌１９８例，均属中晚期，７８例为回顾性分析，１２０例为前瞻性研究，１６２例经手术和病理证实。ＣＴ机为ＧＥＣＴ／９８００Ｑｕｉｃｋ，检查前１０分钟肌注６５４－２２０ｍｇ，口服水１０００ｍｌ作为对比剂，患者体位根据病灶部位而定。结果：采用新的ＣＴ检查技术，病变检出率１００％，定性准确率９０％，采用Ｂｏｒｒｍａｎｎ分型法ＣＴ分型准确性９４．３％，对７５例胃癌进行了前瞻性术前分期研究，采用统一的ＴＮＭ分期，并与手术病理严格对照，胃癌ＣＴ分期总的准确性８５．３３％，术前切除可能性估价的准确性为９２％。结论：采用新的ＣＴ检查技术，利用ＣＴ独特的显示胃腔内面，及胃壁本身腔外改变的优势，可进行胃癌的ＣＴ诊断，分型，分期和术前估价。

MSCT多期扫描及图像后处理在胃癌诊断中的应用

目的探讨多层螺旋CT(multislice spiral computed tomography,MSCT)多期扫描及图像后处理对胃癌的诊断价值。方法收集经病理证实的胃癌患者25例,术前行MSCT平扫、三期动态增强扫描及三维重建扫描,再运用多平面重建、容积重建及CT仿真内窥镜等后处理技术,观察胃癌原发部位、外周浸润及远处转移情况。结果所有患者MSCT图像质量均显示满意,均发现胃部原发病灶并获得胃周浸润、淋巴结转移、远处转移较满意的诊断率。结论MSCT多期扫描及图像后处理可以揭示胃癌原发部位、外周浸润及远处转移情况,对胃癌的诊断、术前评估及治疗方法选择具有重要意义。MSCT可在很大程度上提高微小病变的检出率,可对癌肿侵犯胃壁的深度、区域淋巴结转移、周围脏器浸润以及远处转移情况做出较为准确的判断。MSCT多期扫描及图像后处理可一次性获取多方面信息,可取代胃癌术前评估的X线上消化道造影检查。

64层螺旋CT对进展期胃癌D2根治术中淋巴结清扫的指导价值

目的研究64层螺旋CT(64-slice,CT)对进展期胃癌行D2根治术淋巴结清扫的临床指导价值。方法分析已确诊的进展期胃癌患者(病例组),术前64层螺旋CT检出的淋巴结总数、淋巴结直径(d)和病检结果,并与术前未行64层螺旋CT检查的进展期胃癌患者(对照组)比较术后淋巴结总数、不同直径组淋巴结转移阳性率。结果64层螺旋CT能够检出更多肿大淋巴结,尤其能提高直径(d)<10mm的检出率:d<10mm占89.5%(111/124),d≤5mm占65.3%(81/124),d<3mm占32.3%(40/124)。病例组切除的淋巴结数平均为30枚,其中d<10mm、d≤5mm、d<3mm淋巴结转移率分别为77.7%(108/139)、49.0%(68/139)、18.0%(25/139)。对照组切除的淋巴结数平均为19枚,其中d<10mm、d≤5mm、d<3mm淋巴结转移率分别为52.1%(25/48)、27.1%(13/48)、8.3%(4/48)。结论进展期胃癌术前行64层螺旋CT检查有利于发现小直径淋巴结。

CT在胃癌局部复发诊断中的应用评价

目的 :评价CT检查在胃癌局部复发诊断中的价值和限度。方法 :2组胃癌术后患者接受了CT检查 ,对照组 15例 ,胃镜和病理未见异常 ,用于测量吻合口胃壁厚度 ,观察胃癌术后吻合口CT表现。胃癌术后复发组36例 ,CT诊断为胃癌术后复发 ,经纤维胃镜和 /或外科手术和病理 ,临床化验检查诊断。男 2 1例 ,女 15例。年龄2 2～ 6 5岁 ,平均 5 3岁。CT检查过程中采用多次服水和低张技术 ,CT增强使用动态或螺旋CT多期扫描的检查方法。结果 :残胃吻合口胃壁厚度为 (0 6 5± 0 16 )cm。胃癌局部复发CT表现为胃壁增厚 (14 / 32 ) ,软组织肿块 (6 /32 ) ,混合性病变 (9/ 32 )。病灶在动脉期不均匀强化 2 1例 ,门脉期渐进性显著强化 2 6例 ,平衡期病灶延迟强化 2 8例。 90 19% (46 / 5 1)吻合口得到良好显示 ,CT检出 32个病灶 ,2 9个病例得到正确诊断 ,漏诊 4例 ,误诊 3例。结论 :采用多次服水、低张 ,CT多期扫描或动态增强扫描技术 ,CT可以良好的显示残胃及吻合口 ,提高残胃吻合口局部复发的显示能力 ,可以总体的提高CT在胃癌复发诊断中的应用价值。

胃癌多层CT增强征象与组织分化及p53、P-糖蛋白表达相关性初步探讨

目的初步研究进展期胃癌的多层CT增强征象与肿瘤组织分化及p53、P-糖蛋白(P-gp)表达的关系。资料与方法手术切除且资料完整的胃癌患者66例。所有病例术前均行上腹部多层CT常规及双期增强检查,观察内容包括肿瘤部位、最大直径、胃壁浸润厚度、双期强化率、淋巴结转移等。术后标本经10%甲醛固定、石蜡包埋、组织切片,采用常规HE染色确定组织分化和免疫组织化学检测p53、P-gp在胃癌中表达。比较胃癌的多层CT增强征象与组织分化及p53、P-gp在胃癌表达间的关系。结果73.1%(19/26)均匀强化的胃癌为高/中分化腺癌,75%(30/40)分层强化或不均匀强化的胃癌为低分化腺癌,两者比较差异有统计学意义(P=0.000)。CT双期增强的强化率与胃癌组织分化无关(P>0.05);p53、P-gp在分层强化或不均匀强化的胃癌中阳性表达率显著高于在均匀强化的胃癌中阳性表达(P<0.05)。p53阳性表达还与动脉期强化率、肿瘤大小和淋巴结转移有关(P<0.05),与胃壁浸润厚度、门静脉期强化率无关(P>0.05);而P-gp表达与门静脉期强化率有关(P=0.005),与动脉期强化率、胃壁浸润厚度、肿瘤大小和淋巴结转移无关(P>0.05)。结论胃癌不同的强化方式和双期强化率反映了胃癌的不同组织分化和p53、P-gp阳性表达,提示胃癌的多层CT增强征象与其组织分化及p53、P-gp表达有较密切的相关性。

胃癌侵犯胃裸区的CT解剖及其临床意义

目的:探讨胃癌侵犯胃裸区(GBA)的CT解剖特点及其临床意义。方法:回顾性分析81例CT资料和临床资料完整的胃癌连续性病例,21例侵犯GBA,近侧胃癌(PGC)42例,远侧胃癌(DGC)39例。着重观察GBA受侵后宽度、厚度、密度的变化、左侧膈肌脚受累情况及腹膜后淋巴结转移情况。结果:(1)PGC与DGC在浸润深度、淋巴结转移、TNM分期方面有显著性差异;(2)PGC侵犯GBA发生率(40.5%)明显高于DGC(10.3%);(3)21例胃癌侵犯GBA病例中,有18例CT表现为GBA内软组织肿块(85.7%),9例左侧膈肌脚受侵(42.9%),10例膈下腹膜后淋巴结肿大(47.6%)。结论:胃癌侵犯GBA有一定的CT表现特征和解剖基础,CT术前评价胃癌侵犯GBA有重要意义。