目的:探讨多排CT(multidetector-row CT,MDCT)对胃癌术前分期的价值。方法:对1 311例胃癌病人术前行MDCT检查,并与手术病理结果相对照。结果:MDCT检查对胃癌T分期的判断准确率为75.3%,其中T1期为74.3%,T2~3期为42.9%,T4a期为85.6%,T4b期为81.9%。MDCT检查判断胃癌淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为83.3%、71.8%、81.2%、74.6%和78.6%;对胃癌远处转移的判断分别为70.4%、98.3%、86.9%、95.5%和94.5%;对胃癌肝脏转移的判断分别为74.1%、99.7%、83.3%、99.5%和99.2%;对胃癌腹膜转移的判断分别为54.5%、99.3%、87.1%、96.4%和96.0%;对胃癌远处淋巴结转移的判断分别为76.3%、99.1%、84.1%、98.6%和97.8%。结论:MDCT检查对胃癌术前分期具有较高的临床应用价值,但对胃癌腹膜转移的灵敏度相对偏低,对于腹膜转移概率较大的病人仍需行诊断性腹腔镜检查,以避免不必要的剖腹探查。 Objective: To investigate the value of multidetector-row CT (MDCT) in preoperative staging of gastric cancer. Methods: 1 311 gastric cancer patients underwent MDCT preoperatively and compared with the surgical pathology results. Results: The accuracy of MDCT in diagnosing gastric cancer T stage was 75.3%, of which T1 was 74.3%, T2 ~ 3 42.9%, T4a 85.6% and T4b 81.9%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT were 83.3%, 71.8%, 81.2%, 74.6% and 78.6%, respectively. The rates of distant metastasis of gastric cancer were 70.4% , 98.3%, 86.9%, 95.5% and 94.5%, respectively. The detection rates of liver metastasis of gastric cancer were 74.1%, 99.7%, 83.3%, 99.5% and 99.2% respectively. The judgment of peritoneal metastasis of gastric cancer were 54.5%, 99.3% 87.1%, 96.4% and 96.0% respectively. The distant metastasis of gastric cancer was 76.3%, 99.1%, 84.1%, 98.6% and 97.8% respectively. Conclusion: MDCT has a high clinical value for preoperative staging of gastric cancer, but its sensitivity to peritoneal metastasis of gastric cancer is relatively low. Diagnostic laparoscopy is still required for patients with a high probability of peritoneal metastasis to avoid unnecessary Caesarean section exploration.