增强MDCT特殊重建法对胃癌术前T分期的价值研究

发布时间：2018-12-21 18:19

【摘要】：目的:探讨MDCT特殊多平面重建方法对胃癌T分期术前诊断价值以及比较分析各影像学征象对浆膜受侵价值的研究。材料与方法:对212例经手术病理证实为胃癌的患者进行术前MDCT多期增强检查,将扫描得到的动脉期、静脉期原始图像薄层重建后传输到CT工作站进行MPR重建(包括特殊冠/矢状位及常规冠/矢状位),2名高年资腹部诊断组医师盲法分别对特殊冠/矢状位联合标准横断面及和常规冠/矢状位重建联合标准横断面图像进行分析,包括记录肿瘤部位以及浆膜面受侵情况、肿瘤T分期等。结果:(1)特殊冠/矢状位联合标准横断面和常规冠/矢状位重建联合标准横断面对胃癌T分期准确率分别为83.0%、64.2%(P0.05)。特殊重建法联合标准横断面图像对肿瘤T分期与术后病理T分期Kappa值为0.785,而常规重建法联合标准横断面图像对肿瘤T分期与术后病理T分期Kappa值为0.546。(2)特殊冠/矢状位重建联合标准横断面图像、常规冠/矢状位联合标准横断面图像两种方法在食管胃结合部对T3期、T4a及T4b期胃癌病例准确率分别为96.7%vs80.0%、98.3%vs 80.0%、98.3%vs 90.0%;在胃角部对T3期、T4a及T4b期胃癌病例准确率分别为97.4%vs 73.3%、100%vs 65.8%、100%vs 84.2%(P值均0.05)。(3)MDCT图像上浆膜面毛糙或呈结节状对浆膜受侵判断的准确率(81.1%)高于病变周围脂肪间隙模糊或消失判断浆膜受侵的准确率(71.7%),P0.05。结论:(1)增强MDCT特殊冠/矢状位重建联合标准横断面图像对胃癌T分期的准确性优于常规冠/矢状位重建标准横断面图像,主要体现在对肿瘤位于食管胃结合部以及胃角处T3、T4期的胃癌病例。(2)MDCT图像上浆膜面粗糙或呈结节状对浆膜面受侵判断的准确率更高。
[Abstract]:Objective: to evaluate the value of special multiplanar reconstruction (MDCT) in preoperative diagnosis of gastric cancer in T stage and to compare and analyze the value of different imaging signs in serous invasion. Materials and methods: 212 patients with gastric cancer confirmed by operation and pathology were examined with multiphase MDCT before operation. The original images were transferred to CT workstation for MPR reconstruction (including special coronal / sagittal and conventional coronal / sagittal). Two senior abdominal diagnostics group performed blind analysis of standard cross sectional images of special coronal / sagittal joint and conventional coronal / sagittal reconstruction, including recording of tumor site and serosa invasion. Tumor T stage, et al. Results: (1) the accuracy of special coronal / sagittal joint cross section and conventional coronal / sagittal reconstruction for T staging of gastric cancer was 83.0% (P0.05). The Kappa values of special reconstruction combined with standard cross-sectional images for T staging and postoperative pathological T staging were 0.785, 0.78 5 and 0.78 5, respectively. The Kappa value of conventional reconstruction combined with standard cross-sectional images for T staging and postoperative pathological T staging was 0.546. (2) Special coronal / sagittal reconstruction combined with standard cross-sectional images. The accuracy of conventional coronal / sagittal combined standard cross-sectional images for T3, T4a and T4b gastric cancer cases in esophagus and stomach junction was 96.7vs 80.0 and 98.3 vs 80.098.3 vs 90.0. respectively. The accuracy of gastric cancer in stage T3, T4a and T4b was 73.3% and 73.3%, respectively. 100%vs 84.2% (P = 0. 05). (3) the accuracy rate of serosa invasion on MDCT images was 81.1% higher than that on MDCT images (81.1%). The accuracy of intrusion (71.7%), P0.05. Conclusion: (1) the accuracy of MDCT special coronal / sagittal reconstruction combined with standard cross-sectional images for T staging of gastric cancer is better than that of conventional coronal / sagittal reconstruction standard cross-sectional images. The main results were as follows: (2) the accuracy of serosa surface on MDCT images was higher in judging serous surface invasion of serous surface in patients with gastric cancer at esophagogastric junction and T _ 3N _ T _ 4 stage of stomach angle. (2) the serosa surface was rough or nodular on MDCT images.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2;R730.44;R445.2

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