Halvorsen R A, Thompson W A
Crit Rev Diagn Imaging. 1984;21(3):183-228.
Computed tomography (CT) of the chest and abdomen has proved to be helpful in the preoperative staging of both esophageal and gastric carcinoma. The gastroesophageal junction however, is a difficult area to evaluate as variations in normal anatomy may mimic pathological processes. Pseudomasses at the gastroesophageal junction can be confused with neoplasm. The CT appearance of the GE junction was evaluated in 150 normal patients. CT scans were also performed on 15 patients with carcinoma involving the GE junction. Twenty cases of benign diseases of the GE junction were also studied by CT. Anatomy--The normal anatomy of the gastroesophageal junction will be illustrated with both line diagrams and CT images. The hepatogastric ligament and the caudate lobe of the liver will be demonstrated and their use in locating the GE junction will be shown. Technique--A short segment describing the appropriate technique for CT of the gastroesophageal junction will follow. The use of oral and intravenous contrast will be discussed. The need for distension of the stomach with effervescent agents and oral contrast as well as the use of decubitus and prone positioning will be emphasized when a mass-like density is seen at the GE junction. Examples will be provided. A pseudomass at the GE junction on a supine CT will be shown that disappears with distension and decubitus scanning. This will be used to lead into the next section on neoplasm in which the first example will have an identical appearance on supine CT images. Neoplasm--The relative incidence of gastric adenocarcinoma and esophageal squamous cell carcinoma at the GE junction will be briefly reviewed. The similar CT appearance of the neoplasms will be described and liberally illustrated. Metastatic involvement of lymph nodes adjacent to the GE junction will also be shown. The staging classification for CT evaluation of GE neoplasms will be reviewed. The utility of preoperative staging of esophageal and gastric neoplasms will be briefly reviewed and applied to the GE junction. Our series of patients with cancer of the GE junction will be discussed. The importance of the CT detection of criteria of inoperability will be demonstrated with examples of metastatic involvement of the liver and lymph nodes as well as direct invasion of adjacent organs. Benign Disease--Examples of benign stricture, hiatal hernia, and achalasia will be illustrated. Our cases where CT scans helped rule out a malignant process that had been suggested on barium studies will be reviewed. Summary and Conclusions--Important points of technique, normal anatomy, benign and malignant disease will be briefly reviewed.
计算机断层扫描（CT）已被证明有助于食管癌和胃癌的术前分期。然而，胃食管交界区是一个难以评估的区域，因为正常解剖结构的变异可能会模拟病理过程。胃食管交界区的假肿块可能会与肿瘤混淆。对150例正常患者的胃食管交界区CT表现进行了评估。还对15例累及胃食管交界区的癌患者进行了CT扫描。另外，对20例胃食管交界区良性疾病患者也进行了CT研究。解剖结构——将通过线条图和CT图像展示胃食管交界区的正常解剖结构。将显示肝胃韧带和肝脏尾状叶，并说明它们在定位胃食管交界区中的作用。技术——接下来将有一小节描述胃食管交界区CT的适当技术。将讨论口服和静脉造影剂的使用。当在胃食管交界区看到类似肿块的密度时，将强调使用发泡剂和口服造影剂使胃扩张以及使用侧卧和俯卧位的必要性，并提供实例。将展示仰卧位CT上胃食管交界区的假肿块，其在胃扩张和侧卧扫描时消失。这将用于引出关于肿瘤的下一部分，其中第一个例子在仰卧位CT图像上具有相同的表现。肿瘤——将简要回顾胃食管交界区胃腺癌和食管鳞状细胞癌的相对发病率。将描述并大量举例说明肿瘤相似的CT表现。还将展示胃食管交界区附近淋巴结的转移情况。将回顾胃食管交界区肿瘤CT评估的分期分类。将简要回顾食管和胃肿瘤术前分期的效用，并应用于胃食管交界区。将讨论我们的胃食管交界区癌患者系列。将通过肝和淋巴结转移以及邻近器官直接侵犯的实例说明CT检测不可切除标准的重要性。良性疾病——将举例说明良性狭窄、食管裂孔疝和贲门失弛缓症。将回顾我们的CT扫描有助于排除钡餐检查提示的恶性病变的病例。总结与结论——将简要回顾技术、正常解剖结构、良性和恶性疾病的要点。
