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目的 评价三维螺旋CT(3DCT)在进展期胃癌 (AGC)诊断中的应用价值。方法 1999年6月至 2 0 0 0年 12月连续检查 5 4例AGC患者。 3DCT采用容积重建技术 ,选用 3种方法 ,即仿真内窥镜 (VE)、剪辑体积块 (CVB)、总和投射 (RS) ,并行螺旋CT增强扫描 (2DCT)。分析评价病变显示情况、显示病变形态的能力、Borrman分型、伪影和滞留液。结果 (1)病变显示情况 :以CVB较佳 ,完整显示达 88.9% ,与VE(5 0 .0 % )和RS(38.9% )相比 ,差异有极显著性 (P <0 .0 1)。 (2 )显示病变形态的能力(准确性 ) :除VE评价溃疡为 87.5 %、RS评价黏膜和溃疡分别为 84 .4 %和 81.6 %外 ,3DCT的 3种方法和 2DCT在各项均 >90 .0 % ,VE评估 2DCT难以连续和正斜面显示的黏膜面异常可达 95 .8%。仅在评价溃疡方面 ,CVB与RS、2DCT与RS间差异有显著性 (P <0 .0 5 )。 (3)Borrman分型 :VE符合率为 83.3% ,CVB为 79.6 % ,RS为 72 .2 % ,2DCT为 88.9%。2DCT与RS间差异有显著性 (P <0 .0 5 ) ,综合 3DCT的 3种方法 (85 .2 % )与 2DCT间差异无显著性 (P >0 .0 5 )。 (4)伪影和滞留液 :呼吸伪影仅见于 3DCT ,RS少见 ,VE和CVB较多 ,RS与后二者间差异有极显著性 (P <0 .0 1)。 3DCT可见少量滞留液 ,但不影响诊断。结论 3DCT能够增加对AGC的诊断?
Objective To evaluate the value of three-dimensional spiral computed tomography (3DCT) in the diagnosis of advanced gastric cancer (AGC). Methods From June 1999 to December 2000, 54 consecutive patients with AGC were examined. Volumetric reconstruction was used in 3DCT. Three methods were used, namely VE, CVB, RS and 2DCT. Analysis and evaluation of lesions showed that the ability to display the morphological changes, Borrman classification, artifacts and retention solution. Results (1) Lesion showed that the best was CVB, which showed 88.9% of the total. Compared with VE (50.0%) and RS (38.9%), the difference was statistically significant (P <0.01) . (2) The ability to show the morphology of the lesion (accuracy): 87.5% of the ulcers were evaluated by VE and 84.4% and 81.6% of the ulcers were evaluated by RS. The three methods of 3DCT and 2DCT were> 90 .0%, VE evaluation of 2DCT difficult to continuous and the bevel showed mucosal anomalies up to 95 .8%. Only in the evaluation of ulcer, CVB and RS, 2DCT and RS differences were significant (P <0. 05). (3) Borrman classification: The VE coincidence rate was 83.3%, CVB was 79.6%, RS was 72.2%, 2DCT was 88.9%. There was significant difference between 2DCT and RS (P <0.05). There was no significant difference between 3DCT and 2DCT in the three methods (85.2%) of comprehensive 3DCT (P> 0.05). (4) artifacts and retention solution: Respiratory artifact only seen in 3DCT, RS rare, VE and CVB more, RS and the difference between the latter two were significant (P <0.01). 3DCT visible a small amount of retention solution, but does not affect the diagnosis. Conclusion 3DCT can increase the diagnosis of AGC?