| Objective:To investigate640row of double phase enhancement CT scanning and the use ofcarbonated drinks do the value of contrast agent in TNM staging for gastric cancer.By640row CT detecting advanced gastric cancer in general classification andinfiltration, to investigate640row CT and value gastroscopy to the diagnosis value ofgastric cancer.Materials and methods:Collected a total of46cases of gastric cancer patients, of which male26, female20cases, age34-82, the average age of59, in January2013to January2014. Allpatients have preoperative gastroscopy, preoperative gastroscope biopsy pathologicexamination, abdominal CT scan and enhanced and postoperative pathologicexamination, all groups are surgery. And postoperative pathological examinationswere gastric cancer. All of the patients before the check cannot eat any food for12hours and cannot drink water for6hours. Scan in the first10min intramuscular654-2,20mg, the purpose is to reduce gastric bowel peristalsis cramps and relieve patients’discomfort. Patients in the check within30minutes prior to drink the500mlcarbonated drinks to achieve the goal of gastric cavity expansion.Using the Toshiba640row helical CT scans. Scan parameters: the tube voltage120kv, the current300-350ma, the scanning range is right diaphragmatic top toduodenal horizontal section, and appropriate sweep down level according to differentsituations. Scan dynamic double period after enhancement scanning. Enhanced scanusing MEDAD VISTRON CT high pressure syringe iodine was the formerintravenous nonionic media sea alcohol (300mg/mL) of about300mL, flow rate of3.0mL/s. Using tracer scanning method, arterial phase delay of about20-30s, andvenous phase delay of about40-60s. Conventional supine, according to differentlesion location to sweep the prone position and lateral position.All scan data to a GE3d image workstation, using ADW4.6software and accordingto the need to multiple planar reconstruction (multiplanar reconstruction, MPR) in the workstation.Analysis640row CT examination results and compared with clinical pathologicresults after surgery; In advanced gastric cancer Borrmann general classification,640row CT and gastroscope compared with postoperative pathologic resultsResults:Findings in46patients with gastric cancer pathological T staging: T1phase have4cases, T2stage have15cases. T3phase have18cases, T4have9cases; the T stageof640row helical CT: T1phase in5cases, T2stage in15cases,17were T3, T4phase in9cases; The accuracy of CT on T1-T4staging gastric cancer diagnosisaccuracy were50%,66.7%,72.2%,and77.8%, the total accuracy was69.6%. KAPPacoefficient is0.566. The46cases have had gastric cancer radical surgery, and at thesame time the lymph node groups to stomach, and at the stomach surgery to clean off306lymph nodes; CT detected223lymph node; After pathology confirmed, there are107with lymph node metastasis. When D <1cm it transfer, the positive rate was41.5%, when1cm <D <1.5cm, it transfer, and the positive rate was64%. Thepositive rate is87.5%when D>1.5cm, it transfer. Chi-square value is17.167%, P=0.000<0.001. Which suggest that positive rate exist significant differences during thethree groups. These groups of M0and M1accuracy were85.1%and100%. The totalaccuracy is91.3%, after the judgment of M stage results and pathology resultsconsistency inspection, which found that after kappa coefficient is0.826. It meansthat640M under the row helical CT and pathological staging have a high consistency.According to the description of the proposed parting ways in the form of stomachcancer in general by German pathologist Borrmann, advanced gastric cancer can bedivided into four types. Removed this study of46patients with early gastric cancer in4cases,42cases are advanced gastric cancer.42cases of patients use640row helicalCT to scan, and the diagnosis Borrmann type I or mass type in3cases; Borrmanntype II is limited ulcer type in7cases: Borrmann type III is infiltrating ulcer in11cases; BorrmannIV type in21cases.42patients were also conducted a gastroscopy in the same time, and the diagnosis results of gastroscope Borrmann type I or mass type in2cases; Borrmanntype II limited ulcer type in2cases: Borrmann type III, infiltrating ulcer type in6cases; and BorrmannIV in33cases.Compared to two kinds of diagnostic method for the parting staging diagnosis ofgastric cancer patients, and the clinical outcome such as table3.4. With640row CTBorrmann type with33correct, the accuracy is78.5%, while using gastroscope toBorrmann parting with23points correctly, the accuracy is54.8%. Chi-square=5.357,P=0.036<0.05. Gastroscope and CT accuracy exist significant differences in bothgroups.Conclusion:640row CT to preoperative clinical TNM staging of gastric carcinoma, and theresult has high consistency on the pathology after operation, and the evaluation ofpreoperative clinical surgical procedure has important reference value.In the middle-late gastric cancer Borrmann parting,640row CT is superior toendoscopy, especially for the identified of Borrmann type II and BorrmannIII, anddiagnostic sensitivity and accuracy of BorrmannIV gastric cancer were obviouslyhigher than those of gastroscope. |
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