【摘要】：目的:探討MDCT特殊多平面重建方法對(duì)胃癌T分期術(shù)前診斷價(jià)值以及比較分析各影像學(xué)征象對(duì)漿膜受侵價(jià)值的研究。材料與方法:對(duì)212例經(jīng)手術(shù)病理證實(shí)為胃癌的患者進(jìn)行術(shù)前MDCT多期增強(qiáng)檢查,將掃描得到的動(dòng)脈期、靜脈期原始圖像薄層重建后傳輸?shù)紺T工作站進(jìn)行MPR重建(包括特殊冠/矢狀位及常規(guī)冠/矢狀位),2名高年資腹部診斷組醫(yī)師盲法分別對(duì)特殊冠/矢狀位聯(lián)合標(biāo)準(zhǔn)橫斷面及和常規(guī)冠/矢狀位重建聯(lián)合標(biāo)準(zhǔn)橫斷面圖像進(jìn)行分析,包括記錄腫瘤部位以及漿膜面受侵情況、腫瘤T分期等。結(jié)果:(1)特殊冠/矢狀位聯(lián)合標(biāo)準(zhǔn)橫斷面和常規(guī)冠/矢狀位重建聯(lián)合標(biāo)準(zhǔn)橫斷面對(duì)胃癌T分期準(zhǔn)確率分別為83.0%、64.2%(P0.05)。特殊重建法聯(lián)合標(biāo)準(zhǔn)橫斷面圖像對(duì)腫瘤T分期與術(shù)后病理T分期Kappa值為0.785,而常規(guī)重建法聯(lián)合標(biāo)準(zhǔn)橫斷面圖像對(duì)腫瘤T分期與術(shù)后病理T分期Kappa值為0.546。(2)特殊冠/矢狀位重建聯(lián)合標(biāo)準(zhǔn)橫斷面圖像、常規(guī)冠/矢狀位聯(lián)合標(biāo)準(zhǔn)橫斷面圖像兩種方法在食管胃結(jié)合部對(duì)T3期、T4a及T4b期胃癌病例準(zhǔn)確率分別為96.7%vs80.0%、98.3%vs 80.0%、98.3%vs 90.0%;在胃角部對(duì)T3期、T4a及T4b期胃癌病例準(zhǔn)確率分別為97.4%vs 73.3%、100%vs 65.8%、100%vs 84.2%(P值均0.05)。(3)MDCT圖像上漿膜面毛糙或呈結(jié)節(jié)狀對(duì)漿膜受侵判斷的準(zhǔn)確率(81.1%)高于病變周圍脂肪間隙模糊或消失判斷漿膜受侵的準(zhǔn)確率(71.7%),P0.05。結(jié)論:(1)增強(qiáng)MDCT特殊冠/矢狀位重建聯(lián)合標(biāo)準(zhǔn)橫斷面圖像對(duì)胃癌T分期的準(zhǔn)確性優(yōu)于常規(guī)冠/矢狀位重建標(biāo)準(zhǔn)橫斷面圖像,主要體現(xiàn)在對(duì)腫瘤位于食管胃結(jié)合部以及胃角處T3、T4期的胃癌病例。(2)MDCT圖像上漿膜面粗糙或呈結(jié)節(jié)狀對(duì)漿膜面受侵判斷的準(zhǔn)確率更高。
[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.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2;R730.44;R445.2

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