Gossios K, Tsianos E, Prassopoulos P, Papakonstantinou O, Tsimoyiannis E, Gourtsoyiannis N
Department of Radiology, General Hospital of Ioannina, Greece.
Eur J Radiol. 1998 Nov;29(1):61-70. doi: 10.1016/s0720-048x(98)00024-2.
The purpose of this study was to evaluate by CT the usefulness of the non-distension of the stomach in determining invasion of the gastric cancer into perigastric space and adjacent organs. Forty-eight patients with pathologically proved gastric cancer were studied by conventional CT. Patients were examined using two techniques: (a) non-distension of the stomach in the supine position and 34 patients additionally in prone position; and (b) distension of the stomach with water or air in the supine and/or prone position. CT findings by both techniques were separately analysed preoperatively and compared to surgical findings. Invasion of perigastric fat was better demonstrated by the non-distension technique in 15 of the 36 patients with pathologically proven fat infiltration. Non-distension technique was more accurate than distension in detecting: (a) involvement of gastric ligaments (80 versus 67% for gastrohepatic, 85 versus 73% for gastrocolic and 80% by both techniques for gastrosplenic ligament); (b) perigastric lymphadenopathy (86% by both techniques for lymph nodes sited at the gastrohepatic ligament, 85 versus 75% for gastrocolic and 85 versus 80% for gastrosplenic ligament lymph nodes, respectively); and (c) pancreatic invasion (86 versus 80%). The prone position with non-distended stomach was particularly helpful in excluding pancreatic invasion in five patients with carcinoma of the gastric body. The distension technique was more accurate in demonstrating perigastric extension in gastroesophageal junction tumors in two patients. In conclusion, additional CT of the non-distended stomach with the patient in prone position can provide further evidence about infiltration of the perigastric fat, ligaments, lymph nodes and pancreas, in patients with gastric carcinoma, with the exception of gastroesophageal junction tumors.
本研究的目的是通过CT评估胃未扩张状态在判断胃癌侵犯胃周间隙及相邻器官方面的作用。对48例经病理证实为胃癌的患者进行了传统CT检查。患者采用两种技术进行检查：(a)仰卧位胃未扩张，34例患者还采用了俯卧位；(b)仰卧位和/或俯卧位时用水或空气使胃扩张。术前分别分析两种技术的CT表现，并与手术结果进行比较。在36例经病理证实有脂肪浸润的患者中，15例通过胃未扩张技术能更好地显示胃周脂肪浸润。胃未扩张技术在检测以下情况时比胃扩张技术更准确：(a)胃韧带受累（肝胃韧带：80%对67%，胃结肠韧带：85%对73%，胃脾韧带两种技术均为80%）；(b)胃周淋巴结肿大（肝胃韧带处淋巴结两种技术均为86%，胃结肠韧带处淋巴结：85%对75%，胃脾韧带处淋巴结：85%对80%）；(c)胰腺侵犯（86%对80%）。胃未扩张的俯卧位对排除5例胃体癌患者的胰腺侵犯特别有帮助。胃扩张技术在显示2例胃食管交界部肿瘤的胃周扩展方面更准确。总之，除胃食管交界部肿瘤外，患者俯卧位时对未扩张胃进行CT检查可提供有关胃癌患者胃周脂肪、韧带、淋巴结和胰腺浸润的更多证据。
