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目的:探讨进展期胃癌CT征象与其临床病理特征间的关系。方法:对91例经活检证实的胃癌病人行术前多层螺旋CT(MSCT)检查,分析肿瘤之CT征象(强化程度、瘤周低密度带厚度、CT轴位图像上肿瘤最大径及厚度,以及临床TNM分期)与其临床病理特征的关系。结果:胃癌强化程度与淋巴结转移(P<0.01)、TNM分期(P<0.05)、组织学类型(P<0.001)及性别(P<0.001)均密切相关;而与浸润深度、远处转移、病人年龄及肿瘤部位无关。瘤周低密度带厚度与淋巴结转移(P<0.01)、组织学类型(P<0.001)及肿瘤部位(P<0.05)均密切相关。同时,胃癌强化程度与瘤周低密度带厚度呈线性相关(r=0.366,P<0.001)。CT轴位图像上肿瘤最大径与浸润深度(P<0.05)、淋巴结转移(P<0.05)、TNM分期(P<0.05)、组织学类型(P<0.01)及性别(P<0.05)均密切相关,肿瘤厚度与淋巴结转移(P<0.05)和TNM分期(P<0.05)均密切相关。受试者工作特征(ROC)分析显示,肿瘤强化程度和瘤周低密度带厚度对胃癌组织学类型判断的准确率均较高[ROC曲线下面积(Az)分别为0.74和0.80],且瘤周低密度带厚度对淋巴结转移判断的准确率亦较高(Az=0.74)。胃癌CT分期与病理分期的一致性良好(其中T、N、M和TNM分期的Kappa值分别为0.57、0.45、0.55和0.43)。结论:多层螺旋CT对进展期胃癌术前分期的准确性较高。同时,肿瘤强化程度和瘤周低密度带厚度有助于对胃癌组织学类型的判断,且瘤周低密度带厚度还有助于对淋巴结转移的判断。
Objective: To investigate the relationship between CT features and clinicopathologic features in advanced gastric cancer. Methods: Totally 91 patients with gastric cancer confirmed by biopsy underwent MSCT before operation. The CT features of the tumor (degree of enhancement, thickness of peritumoral low density zone, maximum diameter and thickness of tumor on CT axial images, And clinical TNM staging) and its clinicopathological features. Results: The degree of enhancement of gastric cancer was closely related to lymph node metastasis (P <0.01), TNM stage (P <0.05), histological type (P <0.001) and gender (P <0.001) The patient’s age and tumor site has nothing to do. The density of peritumoral low-density zone was closely related to lymph node metastasis (P <0.01), histological type (P <0.001) and tumor site (P <0.05). At the same time, there was a linear correlation between the intensity of gastric cancer and the density of peritumoral low density (r = 0.366, P <0.001). The diameter of tumor and infiltration depth (P <0.05), lymph node metastasis (P <0.05), TNM stage (P <0.05), histological type (P <0.01) and gender Correlation between tumor thickness and lymph node metastasis (P <0.05) and TNM stage (P <0.05) were closely related. The receiver operating characteristic (ROC) analysis showed that the degree of tumor enhancement and the peritumoral low-density zone thickness were high for the accuracy of histological types of gastric cancer [area under the ROC curve (Az) were 0.74 and 0.80 respectively] Weeks of low-density zone thickness of lymph node metastasis also higher accuracy (Az = 0.74). The consistency of CT staging and pathological staging of gastric cancer was good (the Kappa values of T, N, M and TNM staging were 0.57, 0.45, 0.55 and 0.43, respectively). Conclusion: MSCT has a higher accuracy for preoperative staging of advanced gastric cancer. At the same time, the degree of tumor enhancement and the peritumoral low-density zone thickness contribute to the judgment of the histological type of gastric cancer, and the peritumoral low density zone thickness also contributes to the judgment of lymph node metastasis.