【摘要】 目的　探讨CT在胃原发非霍奇金淋巴瘤与胃癌的鉴别诊断中的应用价值。资料与方法　经手术病理诊断且有CT扫描的胃原发非霍奇金淋巴瘤 19例 ,胃低分化腺癌 48例 ,结合病理诊断对比分析二者胃壁病变厚度、密度、范围、轮廓、与周围脏器的关系及腹腔腹膜后淋巴结肿大的情况。结果　胃淋巴瘤胃壁厚度 0 .4～ 6.5cm ,平均 2 .0 7cm ;胃癌胃壁厚度 0 .5～ 4.0cm ,平均 1.74cm(P =0 .2 93 2 )。胃淋巴瘤淋巴结受侵 10例 ( 5 2 .63 % ) ,CT显示淋巴结肿大 6例 ( 3 1.5 7% ) ,真阳性 3例 ( 15 .8% ) ,其中腹膜后淋巴结肿大 1例 ( 5 .2 6% ) ;胃癌淋巴结转移 3 8例( 90 .48% ) ,CT显示淋巴结肿大 2 0例 ( 47.6% ) ,真阳性 19例 ( 3 9.6% ) ,其中伴腹膜后淋巴结肿大 4例 ( 9.5 2 % )。胃淋巴瘤侵犯胃壁近似全周 4例 ( 2 2 .2 % ) ,≥胃周径 5 0 % 4例 ( 2 2 .2 % ) ,胃癌侵犯近似全周 7例 ( 14.6% ) ,≥胃周径5 0 % 6例 ( 12 .5 % ) ;胃淋巴瘤外侵 5例 ( 2 6.3 2 % ) ,CT阳性 3例 ( 15 .8% ) ,胃癌外侵 42例 ( 87.5 % ) ,CT阳性 3 1例( 64 .5 8% )。结论　CT扫描可以显示胃壁病变的厚度、密度、范围、与周围组织的关系以及腹腔腹膜后淋巴结肿大的情况。胃癌与胃淋巴瘤在密度、厚度上均无显著差异 ,当病变外侵和 /或更多还原

【Abstract】 Objective To evaluate CT in the differential diagnosis between gastric non-Hodgkin lymphoma and gastric carcinoma.Materials and Methods CT findings in 19 patients with primary gastric non-Hodgkin lymphoma (NHL) and in 48 patients with poorly differentiated gastric adenocarcinoma (PDGCa) were retrospectively analyzed. The diagnosis was pathologically proved in all patients. CT observation was focused on the thickness of the diseased gastric wall, the lesion’s density and extent, stomach outline, the involvement of the perigastric fat layer and adjacent organs, and both the abdominal and retroperitoneal lymphadenopathy. CT findings were compared with the pathological results.Results The thickness of gastric wall in NHL and in PDGCa was 0.4～6.5cm (mean 2.07cm) and 0.5～4cm (mean 1.74cm), respectivley, with P=0.2932. Of 19 cases with NHL, pathologically-proved involvement of lymph nodes was seen in 10 (52.63%), CT scan showed lymphadenopathy in 6 (31.57%), with 3 cases being true positive (15.8%) and one case (5.26%) having retroperitoneal lymphadenopathy. Of 48 cases with PDGCa, lymph node metastasis was found in 38 (90.48%), CT scan showed lymphadenopathy in 20 (47.6%), with 19 cases being true positive (39.6%) and 4 cases (9.52%) having retroperitoneal lymphadenopathy. The involvement of almost whole gastric circumference or over half of gastric circumference in NHL was respectively seen in 4 (22.2%) and 4 (22.2%) cases, while in PDGCa was respectively seen in 7 (14.6%) and 6 (12.5%), with no significant statistic difference existing between the two groups. Invasion into perigastric fat layer and/or adjacent organs in NHL and in PDGCa was found in 5 (26.32%) and in 42 (87.5%) cases, with positive CT signs presenting in 3 (15.8%) and in 31 (64.58%) cases, respectively.Conclusion CT can well demonstrate the thickness of the diseased gastric wall, the lesion’s density and extent, the involvement of the adjacent organs and both the abdominal and retroperitoneal lymphadenopathy. No significant difference in lesion’s density and wall thickness exists between NHL and PDGCa. Extragastric involvement and/or abdominal lymphadenopathy are more commonly seen in PDGCa than in NHL, while lesion’s thickness over 4cm and/or gastric involvement over half gastric circumference are more commonly seen in NHL than in PDGCa. Retroperitoneal lymphadenopathy is not a reliable sign for differentiating NHL from PDGCa.更多还原