64排SCT技术在术前评估胃窦癌周围浸润中的应用研究

发布时间：2018-10-31 13:04

【摘要】：目的:分析64排螺旋CT（64-slice spiral computed tomography，64SCT)三期增强扫描及多平面重建（MPR）技术在术前胃窦癌周围浸润中的影像表现，并与手术病理对照。探讨它的应用价值，为临床提供参考。方法:2010年10月至2012年11月河南科技大学第一附属医院经手术病理证实的胃窦癌病例共87例，男47例，女40例，年龄31～87岁，平均年龄54.3岁。CT检查前患者禁食8-12h，使用美国GE公司64排SCT（LightSpeed VCT）行平扫及三期增强扫描。 CT扫描前肌注654-2。87例患者均于MSCT检查后一周内施行胃窦癌切除术，并将MSCT结果与手术病理结果进行对照。由2位高年资的放射科医师盲法分析，意见分歧时通过讨论达到一致意见。采用SPSSl9.0软件包完成数据的统计分析，计数资料采用X2检验,一致性检验采用Kappa检验。结果:(1)MSCT对胃窦癌周围浸润深度（即总的T分期）的准确性为82.76％(72／87)，，与手术病理相关(P0.05)。对T2、T4期胃壁浸润的一致性较好，分别为Kappa值分别为0.725、0.811，对T3期胃壁浸润的一致性稍差，Kappa值为0.522。(2)MSCT结果显示胃窦癌强化程度与浸润深度之间的差异无统计学意义，大小、厚度与浸润深度之间的差异有统计学意义(P0.05)。在门脉期胃窦低分化癌与中、高分化癌强化程度的差异有统计学意义(P0.05)。(3)MSCT结果显示胃窦癌的大小、厚度、强化特点与手术病理之间的差异有统计学意义(P0.05)。(4)MSCT结果显示胃窦癌浸润周围脏器（T4）均为低分化癌。(5)MSCT结果显示胃窦癌浸润肝脏、横结肠、十二指肠、胆囊的准确性较高，网膜的稍低；而网膜的敏感性最低。(6)MSCT结果显示胃窦癌强化特点呈弥漫型的多为低分化癌，病灶浸润深度越深，周围脏器受浸润的几率越高。胃窦癌强化特点呈肠型的多为中或高分化癌，其浸润深度越低，周围脏器受浸润的的几率越低。(7)胃窦癌病灶大多在门静脉期呈显著强化。本组87例胃窦癌中，门脉期呈显著强化的占63．2％(55／87)，平衡期呈显著强化的占31．0％(27／87),动脉期呈显著强化的占5.8％(5／87)。结论:(1)MSCT结果显示胃窦癌周围浸润与手术病理相关。(2)胃窦癌MSCT影像表现（病灶大小、厚度、浸润深度）与手术病理之间具有相关性。MSCT结果显示胃窦癌病灶大小、厚度与浸润深度具有相关性。(3)胃窦癌病灶大多在门静脉期呈显著强化。强化特点与浸润深度（手术病理分期T）无关，强化特点与手术病理等级（中/高低）相关。(4)胃窦癌MSCT三期增强扫描及MPR重建技术对临床治疗方式有重要的指导意义，对胃窦癌周围浸润的正确评估及预后监测有重要价值。
[Abstract]:Objective: to analyze the imaging findings of 64 row spiral CT (64-slice spiral computed tomography,64SCT) phase 3 enhanced scanning and multiplanar reconstruction (MPR) technique in periantral carcinoma of gastric antrum before operation, and to compare them with surgery and pathology. To explore the value of its application and to provide reference for clinical practice. Methods: from October 2010 to November 2012, 87 cases of gastric antral carcinoma were confirmed by operation and pathology in the first affiliated Hospital of Henan University of Science and Technology, 47 males and 40 females, aged 31 to 87 years, with an average age of 54.3 years. The patients fasted for 8 to 12 hours before CT examination. Use GE 64 row SCT (LightSpeed VCT) for plain scan and 3-phase enhanced scan. Patients with gastric antral carcinoma were treated with intramuscular injection of 654-2.87 before CT scan within one week after MSCT examination. The results of MSCT were compared with the results of operation and pathology. Blind analysis was made by two radiologists with high seniority, and consensus was reached when opinions were different. The data were analyzed by SPSSl9.0 software package, X2 test was used for counting data, and Kappa test was used for consistency test. Results: (1) the accuracy of MSCT was 82.76% (72 / 87) in the depth of infiltration around gastric antrum carcinoma (P 0.05). The consistency of gastric wall invasion in T _ (2) T _ (4) stage was better than that in T _ 3 stage (Kappa = 0.725 ~ 0.811), but the consistency of T _ 3 stage gastric wall invasion was a little less than that of T _ (2) T _ (4) stage. The Kappa value was 0.522. (2) the results of MSCT showed that there was no significant difference between the degree of enhancement and the depth of invasion of gastric antrum carcinoma, but the difference between the size, thickness and depth of invasion was statistically significant (P0.05). There was significant difference in the enhancement degree of highly differentiated gastric antrum carcinoma between the portal phase and the middle stage (P0.05). (3) MSCT results showed the size and thickness of gastric antral carcinoma. There was significant difference between enhancement and pathology (P0.05). (4) MSCT results showed that the infiltrating organs (T4) of gastric antral carcinoma were all poorly differentiated carcinomas. (5) MSCT results showed that gastric antral carcinoma infiltrated the liver and transverse colon. The accuracy of duodenum and gallbladder was higher than that of omentum. However, the sensitivity of omentum was the lowest. (6) MSCT results showed that most of the gastric antral carcinoma with diffuse enhancement were poorly differentiated, and the deeper the depth of the lesion was, the higher the probability of invasion of surrounding organs was. The enhancement features of gastric antral carcinoma are mostly middle or well differentiated carcinoma, the lower the depth of invasion, the lower the probability of invasion of surrounding organs. (7) most of the lesions of gastric antral carcinoma are enhanced significantly in portal vein phase. Of 87 cases of gastric antral carcinoma, 63.2% (55 / 87) showed significant enhancement in portal phase, 31.0% (27 / 87) in balance phase and 5.8% (5 / 87) in arterial phase. Conclusion: (1) the results of MSCT showed that the infiltration around gastric antral carcinoma was related to the operation and pathology. (2) there was a correlation between the size, thickness and depth of MSCT imaging of gastric antral carcinoma and the operation pathology. MSCT showed the size of the lesion in gastric antral carcinoma. The thickness was correlated with the depth of invasion. (3) the lesions of gastric antral carcinoma were significantly enhanced in portal vein phase. The enhancement features were not related to the depth of invasion (surgical pathological stage T), but were related to the grade of operation and pathology (middle / low). (4) the three-phase enhanced MSCT scan and MPR reconstruction were of great significance in clinical treatment of gastric antral carcinoma. It has important value for accurate evaluation and prognosis monitoring of periantral carcinoma.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R735.2;R730.44

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