| 诗涔,张欢,刘博,刘欢欢,潘自来,陈克敏,严福华.双源双能CT个性化扫描评估胃癌术前分期[J].中国医学影像技术,2014,30(5):767~771 |
| 双源双能CT个性化扫描评估胃癌术前分期 |
| Dual-source dual-energy computed-tomography combined with personal scanning in preoperative staging of gastric cancer |
| 投稿时间：2013-11-28 修订日期：2014-03-31 |
| DOI： |
| 中文关键词: 胃肿瘤 体层摄影术，X线计算机 小剂量团注测试 |
| 英文关键词:Stomach neoplasms Tomography, X-ray computed Test bolus |
| 基金项目:上海市科委医学引导项目（134119a5900）、上海交通大学医工交叉基金（YG2012MS48）。 |
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| 中文摘要: |
| 目的 探讨个性化调节双源双能CT（DSDECT）扫描对胃癌术前分期的价值。方法 收集经胃镜证实的60例胃癌患者，术前对30例采用常规方式（注射对比后40s及70s扫描，常规组）、30例采用小剂量团注测试（testbolus，TB）方法行增强CT扫描（TB组）。对TB组图像进行MIP和VR重建，观察胃周主要血管显示率及变异情况。将两组术前CT诊断结果分别与术后病理结果进行对照，比较二者对胃癌术前分期的准确性。随机选取30例于16排CT（16排CT组）和27例于64排CT（64排CT组）接受腹部双期增强扫描，比较TB组、16排组及64排CT组的容积CT剂量指数（CTDIvol）。结果 常规组术前T分期准确率为66.67%（20/30），N分期准确率为76.67%（23/30）；TB组T分期准确率为63.33%（19/30），N分期准确率为70.00%（21/30），两组术前T分期、N分期准确率差异均无统计学意义（P均>0.05）。TB组中，胃左动脉、胃网膜左动脉、胃网膜右动脉显示率均为100%（30/30），胃右动脉显示率为80.00%（24/30），腹腔干及其主要分支血管变异率为13.33%（4/30）。TB组辐射剂量低于16排组及64排CT组（P均<0.001）。结论 采用TB技术行腹部CT扫描对胃癌术前分期具有较高准确率，并可清晰显示胃周血管。DSDECT具有低辐射剂量的优势，二者联合应用对胃癌术前分期具有较高价值。 |
| 英文摘要: |
| Objective To explore the value of dual-source dual-energy computed-tomography (DSDECT) combined with personal scanning in preoperative staging of gastric cancer. Methods A total of 60 patients with pathologically proved gastric cancer through endoscopy were enrolled and randomly divided into routine group and TB group (each n=30). Patients in routine group underwent routine dual-phase contrasted CT (scanning time: 40 s, 70 s after injection), while patients in TB group underwent contrasted CT scan using test bolus injection protocol. Findings of DSDECT regarding TN staging were compared with pathological results, and then the accuracy between the two groups were also compared. Images of TB group were reconstructed with MIP and VR to observe perigastric arteries. In addition, a total of 30 patients underwent 16-row CT (16-row CT group) and 27 patients underwent 64-row CT (64-row CT group) were randomly chosen, and upper abdomen dual-phase enhanced scanning was performed. Then CT dose index (CTDIvol) of these patients were compared with that of TB group. Results The overall accuracy in determining T stage of gastric cancer was 66.67% (20/30), and of preoperative N staging was 76.67% (23/30) in routine group. In TB group, the overall accuracy of T stage was 63.33% (19/30), of preoperative N staging of gastric cancer was 70.00% (21/30). There was no statistically significant difference between the two groups in TN staging (all P>0.05). In TB group, the display rates of left gastric artery, right and left gastroepiploic artery were all 100% (30/30), of right gastric artery was 80.00% (24/30), and the artery variations of celiac axis were detected in 4 patients (4/30, 13.33%). The radiation dose of TB group was lower than that of 16 row group and 64 row group (both P<0.001). Conclusion Test bolus scanning can ensure high accuracy of preoperative TN staging, as well as accurately shows the vascular information in patients with gastric cancer. DSDECT has the advantage of low radiation dose, having great value in preoperative staging of gastric cancer combined with test bolus method. |
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