多层螺旋CT对膀胱癌的术前分期价值

目的评价多层螺旋CT检查对膀胱癌的术前分期价值。方法对经手术病理证实的膀胱癌患者48例,男34例,女14例,均行术前多层螺旋CT检查,将肿瘤CT征象与手术病理分期结果进行对照分析。结果 CT检查对膀胱癌的总准确率为76.79%。对于膀胱壁内癌灶(≤T2b期)分期的准确率为79.49%,对于膀胱癌侵犯壁外结构的癌灶(≥T3期)分期准确率为70.59%。结论螺旋CT检查对膀胱癌具有较高的诊断价值,可作为膀胱癌术前常规和主要的检查项目。     

膀胱癌的MSCT诊断

目的：探讨MSCT及其重建技术在膀胱癌诊断中的价值。方法：47例膀胱癌患者均行MSCT平扫及增强扫描,并在工作站行图像重建,分析膀胱癌螺旋CT表现,并与手术病理结果对照。结果：47例膀胱癌CT平扫表现为膀胱壁增厚或突向腔内的结节状软组织密度影,其中9例见钙化。增强扫描病变明显强化,静脉期强化程度最高,延迟期强化程度减退。MIP可显示肿块内迂曲、增粗的血管。结论：螺旋CT及其重建技术能显示肿块的强化方式及膀胱壁的增厚,在膀胱癌诊断中具有重要价值。     

膀胱癌的CT分期与病理对照

目的 分析膀胱癌的CT表现，并与手术病理对照，提高膀胱癌的术前分期诊断水平。方法分析13例膀胱癌的CT表现及术前分期，并与手术病理结果对照。结果膀胱癌主要表现为膀胱壁局限性或弥漫性增厚，形成菜花样肿物向腔内突出，可向壁外生长侵犯盆腔组织器官及淋巴结转移，膀胱周围脂肪间隙模糊。膀胱癌的术前CT分期正确率为69．3％。结论螺旋CT扫描能显示膀胱癌的CT特征及向膀胱壁内、外生长情况，对术前分期有意义。     

螺旋CT三维成像对膀胱癌的诊断价值

目的：探讨螺旋CT三维成像对膀胱癌的诊断价值。方法：对35例膀胱癌患者行螺旋CT容积扫描。图像经后处理获得膀胱立体图像。结果：（1）膀胱三维图像的好坏与扫描方法，图像重建方法等密切相关。（2）膀胱三维图像上可清楚观察到向膀胱内突入的菜花状或乳头状肿块，肿块基底部膀胱壁增厚；并可以多方位观察膀胱轮廓及肿块情况。结论：螺旋CT膀胱三维成像可以从二维及三维立体图像上获得更多诊断信息，具有明显优越性。     

膀胱癌肉瘤的影像学表现(附3例报告并文献复习)

目的分析3例膀胱癌肉瘤的影像学表现特点,提高对其认识。资料与方法搜集经病理确诊的3例膀胱癌肉瘤进行分析,并结合文献进行讨论。结果 3例膀胱癌肉瘤中2例在CT上表现为较大范围不规则的膀胱壁增厚或无蒂肿块,其中1例增强扫描强化较均匀,1例表现为表面或黏膜下强化;1例表现为广基底的突起肿块伴表面不规则钙化,增强扫描强化不均匀。结论膀胱癌肉瘤发病率低,影像上相对缺乏特异性,诊断主要靠病理组织学检查及免疫组织化学染色。但如果病变内部有钙化,MR T2W I像上信号不均且不出现动脉早期显著强化,则应考虑膀胱癌肉瘤的诊断。     

MSCT三期增强扫描和后处理技术对胃癌术前分期的评价

目的:探讨多层螺旋CT(MSCT)对胃癌的影像学诊断及其对术前分期的价值。方法:对49例胃癌患者行16层螺旋CT三期增强扫描后,用多平面重建(MPR)和CT仿真内镜(CTVE)等后处理技术对胃癌CT图像进行术前分期评价,并与术后病理分期对照,以术后病理分期为金标准。结果:MSCT T分期:T1期诊断准确率75.00%(6/8),T2、T3、T4期准确率分别为70.59%(12/17)、68.42%(13/19)、80.00%(4/5);N分期:N0期68.75%(11/16),N1期准确率为59.10%(13/22),N2期63.64%(7/11)。M分期中除1例左锁骨上淋巴结转移未行该部位的CT扫描不计入统计之列外,其余48例M分期的准确率为M0为90.91%(40/44),M1为50.00%(2/4)。结论:16层螺旋CT三期增强扫描结合多平面重建和CT仿真内镜等后处理技术对胃癌分期的准确率较高,值得临床推广。     

薄层CT增强扫描对膀胱癌术前分期的临床价值

目的通过对比膀胱癌薄层螺旋CT与病理诊断结果,评价薄层CT增强扫描对膀胱癌术前分期的临床价值。方法应用美国GE公司ProSpeedⅡ螺旋CT机,对58例膀胱癌患者进行盆腔平行扫瞄、动脉期静扫、静脉期增强薄层扫描。比较薄层螺旋CT分期与病理分期的准确度、敏感度和特异度。结果 58例患者螺旋临床CT分期:T1期9例,T2a期19例,T2b期14例,T3期8例,T4期8例,病理分期:pT1期12例,pT2a期17例,pTb期212例,T3期11例,pT4期6例。CT扫描准确度、敏感度及特异度均有明显优势。结论薄层CT增强扫描用于膀胱癌术前诊断分期,对临床制定治疗方案和预后评估有重要价值。     

多层螺旋CT在原发性十二指肠癌诊断中的应用

目的 评价多层螺旋CT及其后处理技术在诊断原发性十二指肠癌的价值.资料与方法 对7例经手术后病理证实的原发性十二指肠癌患者的多层螺旋CT表现进行回顾性分析.结果 7例中有4例表现为局部软组织肿块影;3例表现为管壁增厚和管腔狭窄;同时表现为局部软组织肿块和管壁增厚、局部管腔狭窄者2例;与胰头分界不清2例;肝内转移1例;肺内转移1例;增强扫描表现为软组织肿块者在动脉期有明显强化,静脉及延迟期强化部分消退明显.结论 多层螺旋CT及其后处理技术对原发性十二指肠癌的诊断和手术分期及指导治疗有价值.     

膀胱癌的MRI诊断价值

目的:总结膀胱癌的MRI征象,探讨MRI对膀胱癌分期的作用及鉴别诊断要点。方法:对探讨经手术与病理证实23例膀胱癌的MRI回顾性对比分析。其中男性,19例,女性,4例,年龄50~90岁,平均年龄70岁。18例行MRI增强检查。结果:膀胱三角区及膀胱后侧壁是最常见好发部位,表现为膀胱壁突向腔内肿块和(或)膀胱壁局限性不规则增厚;肿瘤平扫T1WI等或略高信号,T2WI呈高信号,Gd-DTPA动态增强早期肿块显著强化。根椐肿瘤生长方式可分为:①小结节型,②广基肿块型,③浸润型。MRI对膀胱癌定位、定性诊断正确率分别为95.7%(22/23)、91.3%(21/23);术前MRI诊断与TNM分期符合率为82.3%(19/23),MRI较病理分期偏高。结论:膀胱癌的MRI表现具有独特性。T1加权主要用于肿瘤的定性诊断,T2加权主要用于肿瘤的术前分期;MRI检查多方位、多序列成像,是显示膀胱癌最理想的检查方法。     

脐尿管癌的CT诊断

目的:探讨脐尿管癌的螺旋CT表现特点,提高对本病的认识。方法:回顾性分析7例经手术病理证实的脐尿管癌的螺旋CT表现,包括肿块的部位、形态、大小及增强表现。结果:7例病理均为腺癌或黏液腺癌。CT均表现为脐尿管与膀胱交界区大小不等的软组织肿块,5例肿块同时向腔内外生长,1例腔内生长为主,1例肿块主要位于腔外。肿块形态不规则,6例伴有周围膀胱壁受侵增厚。1例肿块内见多个斑点状钙化。增强扫描5例呈不均匀强化,2例强化均匀,7例静脉期均明显强化。结论:脐尿管肿瘤有其独特的发生部位,影像表现典型,术前CT检查能够做出准确定位与定性诊断。     

Preoperative staging of gastric carcinoma with multidetector spiral CT

PURPOSE: To assess the accuracy of Multidetector computed tomography (MDCT) in the preoperative staging of gastric cancer. MATERIALS AND METHODS: Between March 2002 and October 2002, 27 patents with histologically proven gastric adenocarcinoma underwent MDCT. Unenhanced and contrast-enhanced CT scans were obtained after the oral administration of 400-600 ml of water for gastric wall distension. Biphasic enhanced scans were performed after the automatic injection of 2ml/kg of contrast agent at a flow rate of 3.5 ml/sec with a scan delay of 35 and 70 sec. The images were evaluated for: lesion morphology, degree of wall infiltration, presence of locoregional lymphadenopathies and distant metastases. Based on the findings, a TCMD staging system was established according to the criteria reported in the literature. All the patients underwent surgery, and the preoperative MDCT staging was evaluated against the pathology findings. RESULTS: MDCT staging was correct in 17/27 patients (62.9%). The T parameter was correctly assessed in 24/27 cases (88.9%), whereas it was understaged in 1 case (3.7%) (T1 stage at CT vs T2 at surgery) and overstaged in 2 cases (7.4%) (T3 vs T2). The N parameter was correctly evaluated in 19/27 patients (70.4%), understaged in 6/27 (22.2%) and overstaged in 2/27 (7.4%). CONCLUSIONS: MDCT may be proposed for the staging of gastric carcinomas and, although accuracy in N staging remains low in comparison to single-detector spiral CT, it provides a larger amount of diagnostic information.     

原发性输尿管癌的多层螺旋CT诊断

目的:探讨多层螺旋CT(MSCT)容积扫描对输尿管癌的诊断价值。方法:搜集应用多层螺旋CT容积扫描并经病理证实15例原发性输尿管癌,对其MSCT影像征象进行分析。结果:15例原发输尿管癌发生于下段7例,上段2例,中段1例,左肾盂、输尿管、膀胱同时受累2例,输尿管下段及膀胱同时发生3例。MSCT上表现为病变输尿管管腔内软组织块或管壁不均匀增厚,管腔变窄,在多平面重建图像上呈柱状,3例同时发现腹膜后淋巴结肿大,影像所见与手术及病理结果完全符合。结论:MSCT容积扫描能清楚显示原发输尿管癌部位、范围,可进行肿瘤分期,是极好的影像学检查方法。     

Preoperative staging of esophageal carcinoma with multidetector CT and virtual endoscopy

PURPOSE: The aim of this study was to assess the accuracy of multidetector computed tomography (MDCT), including virtual endoscopy (VE) for detection, precise localization, preoperative evaluation and staging of esophageal cancer (EC) by comparison with surgical and histopathological findings. MATERIALS AND METHODS: Between September 2003 and April 2005, 44 patients with histologically proven EC underwent MDCT and VE. Among 44 patients, the findings were confirmed in 24 at surgery. The accuracy of three-dimensional MDCT for detection, localization, and staging of EC was determined, and compared with surgical finding and histopathology. RESULTS: The overall accuracy of three-dimensional multidetector row CT for detection of EC was 100% (24/24). MDCT staging was correct in 20 patients (83.3%). The T parameter was correctly assessed in 22 (91.7%) cases (understaged in 1 and overstaged in 1). The N parameter was correctly evaluated in 20 (83.4%) patients (understaged in 2 and overstaged in 2). The overall accuracy of VE for the morphologic classification of EC was 81.5%. CONCLUSIONS: Three-dimensional MDCT, along with VE is a promising method for preoperative evaluation and staging of EC. Although accuracy in N staging remains low in comparison to PET, it provides a larger amount of diagnostic and staging information.     

多排螺旋CT在胃癌术前TN分期中的应用价值

目的:利用多层螺旋CT(MDCT),前瞻性的对胃癌进行术前TN分期,并与术后病理结果对照,评估其分期的准确性及临床价值。方法:对经胃镜证实的48例胃癌患者,于术前进行MDCT三期动态增强扫描。分别利用CT轴位图像和轴位结合多层面重组(MPR)图像对胃癌进行TN分期,并将CT分期结果与术后病理结果相对照,分期的准确性比较采用McNemar检验,取P<0.05为检验标准。结果:轴位和轴位结合MPR对胃癌病灶的检出率分别为91.6%(44/48)、97.9%(47/48)。轴位和轴位结合MPR对所有患者胃癌胃壁浸润深度(T分期)评估的准确率的分别为72.9%(35/48)、89.5%(43/48),两者之间差异具有统计学意义(P=0.041)。轴位和轴位结合MPR对所有患者转移淋巴结(N分期)评估的准确率的分别为72.9%(35/48)、77.1%(37/48),两者之间差异没有统计学意义(P=0.113)。结论:MDCT能对胃癌术前TN分期做出较准确的评估。MPR能显著改善胃癌T分期的准确率,但不能明显提高N分期的准确率。     

MSCT在胃癌病理分期及诊断中的应用价值

目的：探讨胃癌的 CT 表现特征,评价其在分期诊断中的应用价值。方法：搜集有完整手术病理的胃癌患者500例,通过将 CT 检查结果与胃癌的大小、位置、形状、强化程度以及肿瘤侵犯范围进行对比,对 CT 的分期诊断准确度进行评价。结果：胃癌病灶长度、厚度与病理 T 分期均呈显著正相关（P ＜0．001）。胃癌病灶好发于胃窦及贲门部。500例胃癌患者中最常见的类型为蕈样型（79．0％,395／500）。胃癌病灶在静脉期及延迟期的 CT 值随着 T 分期逐级升高而增大,差异有统计学意义（P ＜0．05）。T3期中胃周脂肪模糊型所占比例为76．64％,T4期中浆膜高强化型所占比例为86．36％。MSCT 诊断胃癌 T1期的准确度为91．23％,T2期准确度为89．01％,T3期准确度为87．64％,T4期准确度为98．74％。结论：MSCT 有助于更准确地判断肿瘤的浸润程度,能够较准确地对胃癌的 T 分期进行判断。     

Diagnostic accuracy of multidetector row computed tomography in T- and N staging of gastric cancer with histopathologic correlation

PURPOSE: To evaluate the diagnostic accuracy of multidetector row computed tomography (MDCT) for the preoperative T- and N staging of gastric cancer. MATERIALS AND METHODS: Eighty-four consecutive patients with gastric cancer underwent preoperative MDCT. Except for 15 patients who did not undergo surgery, 69 patients were included in our study. Two radiologists independently evaluated the T- and N staging on the axial CT images alone and in combination with the MPR images. For N staging, the new TNM and Japanese classifications were independently used. Differences in staging accuracy for T- and N staging were assessed using the McNemar test. RESULTS: The overall T staging accuracy of the axial and combined axial and MPR images was as follows: 67% (47 of 70 cancers) versus 77% (54 of 70 cancers) (P=0.039). The overall N staging accuracy of the axial and combined axial and MPR images was as follows: 59% (41 of 69 cancers) versus 67% (46 of 69 cancers) (P=0.180, Japanese classification) and 54% (37 of 69 cancers) versus 59% (41 of 69 cancers) (P=0.109, TNM classification). CONCLUSIONS: Using MPR images enables more accurate preoperative T staging of gastric cancer, but not for N staging in either classification system.     

Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging

PURPOSE: To evaluate the enhancement pattern of bladder cancer and the accuracy of multi-detector row helical computed tomography (CT) in the detection and staging of bladder cancer. MATERIALS AND METHODS: In 20 patients, the attenuation value of bladder cancer was measured on dynamic contrast material-enhanced multiphasic CT images obtained with scanning delays of 40, 60, 80, and 100 seconds. In 67 patients, CT data were obtained with a 60-second scanning delay that covered the bladder (section thickness, 2.5 mm; beam pitch, 1.5) and a 180-second scanning delay that covered the abdomen (section thickness, 5 mm; beam pitch, 1.5). We prospectively evaluated CT images and compared findings at CT with findings at histologic examination. We evaluated cancer detection rate, positive predictive value of cancer detection, and sensitivity and specificity in the diagnosis of perivesical invasion. RESULTS: The attenuation value of bladder cancers was significantly higher on 60- (105 HU +/- 16) and 80-second (97 HU +/- 15) delayed CT images than on the other images (P <.05). The cancer detection rate and positive predictive value for cancer detection were 97% and 95%, respectively, in 67 patients and increased to 100% and 100%, respectively, in 44 patients with a time interval of 7 or more days between transurethral resection of the bladder (TURB) and CT examination. Sensitivity and specificity in the diagnosis of perivesical invasion were 89% and 95%, respectively, in 67 patients and increased to 92% and 98%, respectively, in 44 patients with a time interval of 7 or more days between TURB and CT examination. CONCLUSION: Bladder cancer tends to show peak enhancement with the 60-second scanning delay. Multi-detector row helical CT is useful in the detection and staging of bladder cancer.     

Determining gastric cancer resectability by dynamic MDCT

Purpose

Multi-detector row CT (MDCT) has been widely used to detect primary lesions and to evaluate TNM staging. In this study we evaluated the accuracy of dynamic MDCT in the preoperative determination of the resectability of gastric cancer.

Methods

MDCT was used to image 350 cases of gastric cancer diagnosed by biopsy before surgery. MDCT findings regarding TNM staging and resectability were correlated with surgical and pathological findings.

Results

The accuracy of MDCT for staging gastric cancer was high, especially for tumour stage T1 (94.3%), lymph node stage N2 (87.3%), and for predicting distant metastases (>96.6%). When resectability was considered to be the outcome, the total accuracy of MDCT was 87.4%, sensitivity was 89.7% and specificity was 76.7%. Results showed high sensitivity for identifying peritoneal seeding (90.0%) and for predicting liver metastasis (80.0%).

Conclusion

Dynamic enhanced MDCT is useful for TNM staging of gastric cancers and for predicting tumour respectability preoperatively.     

Diagnosis of gastric cancer with MDCT using the water-filling method and multiplanar reconstruction: CT-histologic correlation

OBJECTIVE: The purpose of this study was to assess the utility of MDCT with a thin-sliced multiplanar reconstruction (MPR) technique and water-filling method for the diagnosis of gastric cancers. MATERIALS AND METHODS: Sixty-five patients with gastric cancers were preoperatively examined with MDCT using the water-filling method. The abdomen was dynamically scanned at 30 and 80 sec after the start of contrast medium administration. MPR images were reconstructed with a slice width of 1.25 mm and a slice interval of 1 mm. The detection rate and accuracy of T staging for gastric cancer were evaluated on MPR images and compared with 5-mm-slice axial images. In addition, MDCT images were correlated with pathologic findings. RESULTS: The detection rate of all gastric cancers using the MPR technique was 65%. The detection rate of advanced gastric cancers was 96.2% (25 of 26), whereas that of early gastric cancers was 41.2% (14 of 34). There was a statistically significant difference (p < 0.05) in the detection rate of early gastric cancers between MPR and 5-mm-slice axial images. The MDCT appearances of gastric cancers were well correlated with pathologic findings such as mucinous component or differences in infiltration of cancer cells. The overall accuracy of CT staging was 85%. MPR images were superior to axial images for the evaluation of the z-axis extent of tumor. CONCLUSION: MDCT with the water-filling method has advantages in acceptable evaluation of depth invasion of gastric carcinomas and in visualization of histologic changes in the tumors. MPR images may be a useful guide for the evaluation of the z-axis extent of tumor.