64排SCT技術(shù)在術(shù)前評(píng)估胃竇癌周圍浸潤(rùn)中的應(yīng)用研究
發(fā)布時(shí)間：2018-10-31 13:04
【摘要】：目的:分析64排螺旋CT（64-slice spiral computed tomography，64SCT)三期增強(qiáng)掃描及多平面重建（MPR）技術(shù)在術(shù)前胃竇癌周圍浸潤(rùn)中的影像表現(xiàn)，并與手術(shù)病理對(duì)照。探討它的應(yīng)用價(jià)值，為臨床提供參考。 方法:2010年10月至2012年11月河南科技大學(xué)第一附屬醫(yī)院經(jīng)手術(shù)病理證實(shí)的胃竇癌病例共87例，男47例，女40例，年齡31～87歲，平均年齡54.3歲。CT檢查前患者禁食8-12h，使用美國(guó)GE公司64排SCT（LightSpeed VCT）行平掃及三期增強(qiáng)掃描。 CT掃描前肌注654-2。87例患者均于MSCT檢查后一周內(nèi)施行胃竇癌切除術(shù)，并將MSCT結(jié)果與手術(shù)病理結(jié)果進(jìn)行對(duì)照。由2位高年資的放射科醫(yī)師盲法分析，意見分歧時(shí)通過(guò)討論達(dá)到一致意見。采用SPSSl9.0軟件包完成數(shù)據(jù)的統(tǒng)計(jì)分析，計(jì)數(shù)資料采用X2檢驗(yàn),一致性檢驗(yàn)采用Kappa檢驗(yàn)。 結(jié)果:(1)MSCT對(duì)胃竇癌周圍浸潤(rùn)深度（即總的T分期）的準(zhǔn)確性為82.76％(72／87)，，與手術(shù)病理相關(guān)(P0.05)。對(duì)T2、T4期胃壁浸潤(rùn)的一致性較好，分別為Kappa值分別為0.725、0.811，對(duì)T3期胃壁浸潤(rùn)的一致性稍差，Kappa值為0.522。(2)MSCT結(jié)果顯示胃竇癌強(qiáng)化程度與浸潤(rùn)深度之間的差異無(wú)統(tǒng)計(jì)學(xué)意義，大小、厚度與浸潤(rùn)深度之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在門脈期胃竇低分化癌與中、高分化癌強(qiáng)化程度的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)MSCT結(jié)果顯示胃竇癌的大小、厚度、強(qiáng)化特點(diǎn)與手術(shù)病理之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)MSCT結(jié)果顯示胃竇癌浸潤(rùn)周圍臟器（T4）均為低分化癌。(5)MSCT結(jié)果顯示胃竇癌浸潤(rùn)肝臟、橫結(jié)腸、十二指腸、膽囊的準(zhǔn)確性較高，網(wǎng)膜的稍低；而網(wǎng)膜的敏感性最低。(6)MSCT結(jié)果顯示胃竇癌強(qiáng)化特點(diǎn)呈彌漫型的多為低分化癌，病灶浸潤(rùn)深度越深，周圍臟器受浸潤(rùn)的幾率越高。胃竇癌強(qiáng)化特點(diǎn)呈腸型的多為中或高分化癌，其浸潤(rùn)深度越低，周圍臟器受浸潤(rùn)的的幾率越低。(7)胃竇癌病灶大多在門靜脈期呈顯著強(qiáng)化。本組87例胃竇癌中，門脈期呈顯著強(qiáng)化的占63．2％(55／87)，平衡期呈顯著強(qiáng)化的占31．0％(27／87),動(dòng)脈期呈顯著強(qiáng)化的占5.8％(5／87)。 結(jié)論:(1)MSCT結(jié)果顯示胃竇癌周圍浸潤(rùn)與手術(shù)病理相關(guān)。(2)胃竇癌MSCT影像表現(xiàn)（病灶大小、厚度、浸潤(rùn)深度）與手術(shù)病理之間具有相關(guān)性。MSCT結(jié)果顯示胃竇癌病灶大小、厚度與浸潤(rùn)深度具有相關(guān)性。(3)胃竇癌病灶大多在門靜脈期呈顯著強(qiáng)化。強(qiáng)化特點(diǎn)與浸潤(rùn)深度（手術(shù)病理分期T）無(wú)關(guān)，強(qiáng)化特點(diǎn)與手術(shù)病理等級(jí)（中/高低）相關(guān)。(4)胃竇癌MSCT三期增強(qiáng)掃描及MPR重建技術(shù)對(duì)臨床治療方式有重要的指導(dǎo)意義，對(duì)胃竇癌周圍浸潤(rùn)的正確評(píng)估及預(yù)后監(jiān)測(cè)有重要價(jià)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.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R735.2;R730.44
[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.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R735.2;R730.44
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