摘要
目的前瞻性研究多层螺旋CT多平面重组(MPR)在胃癌术前T、N分期中的价值。资料与方法经本院医学伦理委员会批准,在与所有受检者签署书面知情同意书后,对连续44例经胃镜活检证实的胃癌患者,采用多层螺旋CT在服产气粉和水(500~1000ml)充分扩张胃后行低张动态增强扫描,其中39例手术的病例入选此次研究。由一名放射诊断医师采用交互方式实时MPR确定能较好地显示病灶和毗邻组织器官结构关系的成像方位进行重组。由两名经验丰富的放射诊断医师分别依据横断位及MPR图像通过协商对肿瘤的显示和T、N分期进行评价,并与病理组织结果对比。采用McNemar检验比较横断图像和MPR图像对原发肿瘤的显示以及T和N分期的准确性有无差别,P<0.05认为有统计学意义。由一名即将参与手术的外科医师评估横断位和MPR图像对传递诊断信息的效率。结果对原发胃癌病灶的检出率,横断图像和MPR图像分别是94.9%(37/39)和97.6%(38/39)。MPR评估胃癌灶对胃壁侵犯深度(T分期)的准确性为87.2%(34/39),较横断图像的61.5%(24/39)高(P=0.002)。MPR对淋巴结转移评价(N分期)的准确性为69.2%(27/39),横断图像的准确性为59.0%(23/39),两者差异无统计学意义(P=0.125)。对39例病例,手术医师均倾向于接受MPR,认为MPR更能有效传递诊断报告所表达的信息。结论虽然未能提高N分期的准确性,但多层螺旋CT的MPR图像能提高胃癌局部侵犯术前分期的准确性,增强与临床医师间的信息传递,值得在临床推广。
Objective To prospectively investigate the value of multi slice spiral CT (MSCT)with multi-planer reformation (MPR)for preoperative T-and N staging of gastric cancer. Materials and Methods This prospective study was approved by the institute ethic committee of clinical study.Information consent forms were obtained from all patients. Forty-four consecutive patients with gastric cancer,which was confirmed by biopsy through gastroscopy,underwent dynamic enhanced CT with adequate stomach distention after taken aerogenic powder and 500-1000 ml water. Thirty-nine patients who underwent operations were included in this study. MPR images were obtained at optimal plane to depict the relationship of lesion with adjacent organs and tissue using an interactive real-time manner. Two experienced radiologists evaluated T and N staging on the transverse and MPR images in consensus. T and N staging on CT was compared with the histopathologic results. McNemar exact test was applied to assess the accuracy of transverse and MPR images for T and N staging. A surgeon was invited to evaluate the accuracy of CT report. Results Detection rate of primary tumors with transverse and MPR images were 94.9% (37 of 39),97.6% (38 of 39),respectively. The accuracy for MPR images in assessment of tumor invasion of the gastric wall (T staging) was 87.2%(34 of 39),which was higher than that for transverse images [61.5%(24 of 39)] (P=0.002). Overall accuracy for lymph node (N) staging was 69.2%(27 of 39)with MPR images and 59%(23 of 39)with transverse images,respectively. This difference was not statistically significant (P=0.125). The surgeons preferred MPR to transverse images to assess T and N staging in all 39 patients. Conclusion Although MPR images can not improve the accuracy of lymph node (N) staging,it can improve the accuracy of local invasion of gastric cancer(T staging),and facility in information transfer between radiologists and relative clinicians. It is worth recommending at clinical application.
出处
《临床放射学杂志》
CSCD
北大核心
2010年第5期629-633,共5页
Journal of Clinical Radiology
基金
广东省深圳市科技计划项目(编号:200902001)
关键词
胃癌
螺旋CT
T分期
N分期
Stomach cancer
Multi slice CT (MSCT)
T staging
N staging
