摘要
目的通过X线气钡双对比造影和CT两种手段结合,评价相关影像学指标与食管胃交界部(EGJ)癌手术路径(单纯经腹或胸腹联合)的相关性。方法回顾性分析我院胃肠外科初诊EGJ癌并行根治性切除的35例患者资料。术前均行X线造影及胸腹部增强CT扫描。X线造影选择半立位大角度右前斜位测量贲门口至食管受累上缘的长度。CT轴位及重建冠、矢状位图像上测量癌肿累及食管的长度,并评价淋巴结转移情况。比较开胸与非开胸组X线造影及CT各方位测量EGJ癌累及食管长度值的差异。采用受试者工作特征曲线比较各种方法判断手术是否需要开胸的评价效能。结果经胸腹联合手术切除15例,经腹部手术切除20例。X线造影和CT矢状位测量所得癌肿累及食管长度在单纯经腹和胸腹联合组间差异有统计学意义(P<0.05),胸腹联合组长度值较大。比较4种手段测量所得癌肿长度预测手术是否开胸的效能,曲线下面积由高到低分别为0.737(X线造影)、0.716(CT矢状位)、0.591(CT冠状位)及0.561(CT轴位)。取X线造影显示癌肿累及食管长度>4 cm作为截割点判断手术需要开胸,敏感性为86.6%,特异性为70%。进一步联合CT判断食管旁或隆突淋巴结转移者评价术中开胸的效能,受试者工作特征曲线下面积由0.737提高至0.847,诊断敏感性及特异性分别提高至93.33%和70%。结论 X线造影测量食管浸润长度和CT评价纵隔淋巴结转移情况,与EJG癌手术路径的选择具有一定相关性。
Objective To investigate the ability of X ray double contrast imaging and CT in the judgment of operation pathway （trans-abdominal or trans-thoracic-abdominal） in patients with esophagogastric junction （EGJ） carcinomas. Methods 35 patients with EGJ carcinomas were enrolled in the srydy. The patients underwent preoperative X ray double contrast barium examination and enhanced CT scan. The distance between the cardia and upper border of invaded esopha- gus was measured on large angle right anterior oblique position. The length of the invaded esophagus was measured on axi- al, coronal and sagittal CT images, respectively. Lymph node metastasis was evaluated on CT images as well. The lengths of the invaded esophagus measured on X ray images and CT images were compared. Receiver operating characteristic curves （ROC） were drawn to compare the ability of various methods in determining thoracotomy. Results There were 15 cases underwent trans thoracic abdominal operation and 20 cases underwent trans abdominal operation. There was statistical sig- nificant difference of the invaded length between the two kind of operations （ P 〈 0.05 ）. The AUCs were 0. 737 for X-ray double contrast imaging, 0. 716 for CT sagittal planes, 0. 591 for CT coronal planes and 0.561 for CT axial planes. Taken the length 〉 4cm measured on X-ray imaging as threshold value to judge trans-thoracic-abdominal operation, the sensitivity and specificity was 86.6% and 70%. Further combined the lymph node metastasis evaluated on CT images, the AUC in- creased from 0. 737 to 0. 847, and the diagnostic sensitivity increased to 93.33%, but specificity remained at 70%. Con- clusion Combined X-ray double contrast imaging with CT can provide reference for preoperative evaluation of the operation pathway in patients with EGJ carcinomas.
出处
《临床放射学杂志》
CSCD
北大核心
2013年第8期1202-1205,共4页
Journal of Clinical Radiology
关键词
食管胃交界部癌
体层摄影术
X线计算机
双对比造影
Esophagogastric junction cancers Tomgraphy,X-ray computed Double contrast examination
