【摘要】 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?更多还原

【Abstract】 Objective To study the usefulness of three-dimensional spiral CT (3DCT) in the diagnosis of advanced gastric cancer (AGC). Methods Between June 1999 and December 2000,54 patients with AGC were consecutively examined. On the 3D Virtuoso workstation,source images were uploaded to create a 3DCT volume block that was then processed with volume rendering technology (VA30C) to achieve virtual-reality endoscopy (VE),clipped volume block (CVB),and ray sum (RS). After the above scanning,all the patients were examined by a two-phase enhanced spiral CT (2DCT). The visualization,manifestation,and Borrman′s classification of lesions in VE,CVB,RS,and 2DCT were evaluated and correlated with gastroscopic,surgical,and pathological findings. Respiratory artifact and gastric residue were also observed. Results (1) CVB showed the excellent visualization in 88.9% of cases,in contrast to VE and RS (50.0% and 38.9%) (P<0.01). (2) The accuracy in evaluating mucous membrane,ulceration,lumen,wall,cardia,pylorus,and extension of the tumor were more than 90.0% except mucosa by RS (84.4%) and ulceration by VE (87.5%) or RS (81.6%) which was significantly different from CVB (96.0%) and 2DCT (96.1%) (P<0.05). VE demonstrated an accuracy of 95.8% in diagnosis of mucosal abnormality. (3) The correct Borrman′s classification was obtained in 83.3% cases by VE,79.6% by CVB,72.2% by RS,88.9% by 2DCT and 85.2% by 3DCT with significant difference between 2DCT and RS (P<0.05),but not between 3DCT and 2DCT (P>0.05). (4) In addition to 2DCT which had no step-like artifacts,they were invisible in 53.7% of VE,40.7% of CVB,and 81.5% of RS,with RS showing the least artifacts among 3DCT (P<0.01). A few of gastric residues caused by pre-scanning intake of water to swallow effervescent agent could be found on 3DCT images which caused no evident influence on diagnosis. Conclusion Additional information on the diagnosis of AGC can be obtained by use of 3DCT,especially the visualization of a lesion in clipped volume block and the observation of mucosa in virtual-reality endoscopy.更多还原