多期增强CT三维重建在检测胃癌浸润深度、淋巴结转移及壁外血管侵犯中的价值
Value of multiphase contrast-enhanced CT with three-dimensional reconstruction in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion of gastric cancer.
作者信息
Wang Junda, Zhong Lijuan, Zhou Xinjie, Chen Demei, Li Rui
机构信息
Department of Ultrasound, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
出版信息
J Gastrointest Oncol. 2021 Aug;12(4):1351-1362. doi: 10.21037/jgo-21-276.
BACKGROUND
Multiphase contrast-enhanced computed tomography (CECT) can reveal the location, morphology, size, and enhancement pattern of gastric cancer (GC), whereas the three-dimensional reconstruction (3DR) technique can better display the relationships of the lesions with surrounding structures, the feeding vessels, and lymph node metastasis. Here, we investigated the value of multi-phase CECT with 3DR in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion (EMVI) of GC.
METHODS
The clinical and imaging data of 132 GC patients admitted to the Chongqing Hospital of Traditional Chinese Medicine and the Third Affiliated Hospital of Chongqing Medical University during the period from January 2012 to October 2019 were collected. All patients received plain and multiphase contrast-enhanced CT scans. The agreement between the results of preoperative CT evaluation and the surgical/pathological findings was compared.
RESULTS
(I) CT findings of GC of 3 differentiation levels: on the multiphase CECT, the peak enhancement percentage was highest in the portal venous phase. The CT values significantly differed among the arterial, portal venous, and equilibrium phases (P<0.05); the differences in the arterial, portal venous, and equilibrium phases were statistically significant among the well-, moderately, and poorly differentiated groups (all P<0.05); finally, the difference in the equilibrium phase was statistically significant between the well- and moderately differentiated groups (P<0.05). (II) Preoperative CT and postoperative pathology had good consistency in T staging (Kappa =0.667). (III) The Kappa values between the preoperative CT-diagnosed lymph node metastasis and postoperative pathologically showing an increasing consistency with the increase of CT enhancement differences. (IV) Preoperative CT and postoperative pathology had good consistency in N staging (Kappa =0.779). (V) Preoperative CT in displaying arterial supply to the stomach. The rate of positive EMVI was 32.6% (43/132) on preoperative CT. The positive EMVI diagnosed by preoperative CT was correlated with tumor size, growth pattern, tissue differentiation degree, T stage, and N stage (all P<0.05).
CONCLUSIONS
Multiphase CECT combined with 3DR has high diagnostic performance in detecting the depth of infiltration, lymph node metastasis, and EMVI of GC.
背景
多期增强计算机断层扫描（CECT）可显示胃癌（GC）的位置、形态、大小及强化模式，而三维重建（3DR）技术能更好地显示病变与周围结构、供血血管及淋巴结转移的关系。在此，我们探讨了多期CECT联合3DR在检测GC浸润深度、淋巴结转移及壁外血管侵犯（EMVI）方面的价值。
方法
收集2012年1月至2019年10月期间重庆中医医院和重庆医科大学附属第三医院收治的132例GC患者的临床及影像资料。所有患者均接受平扫及多期增强CT扫描。比较术前CT评估结果与手术/病理结果之间的一致性。
结果
（I）3种分化程度GC的CT表现：在多期CECT上，门静脉期的峰值强化百分比最高。动脉期、门静脉期和平衡期的CT值差异有统计学意义（P<0.05）；高分化、中分化和低分化组在动脉期、门静脉期和平衡期的差异均有统计学意义（均P<0.05）；最后，高分化组与中分化组在平衡期的差异有统计学意义（P<0.05）。（II）术前CT与术后病理在T分期方面具有良好的一致性（Kappa =0.667）。（III）术前CT诊断的淋巴结转移与术后病理显示的Kappa值随CT强化差异的增加而一致性增加。（IV）术前CT与术后病理在N分期方面具有良好的一致性（Kappa =0.779）。（V）术前CT显示胃的动脉供血。术前CT上EMVI阳性率为32.6%（43/132）。术前CT诊断的EMVI阳性与肿瘤大小、生长方式、组织分化程度、T分期和N分期相关（均P<0.05）。
结论
多期CECT联合3DR在检测GC浸润深度、淋巴结转移及EMVI方面具有较高的诊断性能。
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