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Study on the Value of 320-Slice VCT in preoperative TNM staging and gross typeObjectiveTo investigate the value of 320 slice volume CT in preoperative typing and TNM staging of gastric cancer.Materials and Methods68 cases of gastric carcinoma confirmed by histopathological examination.All patients underwent CT plain scaned and sthree phases contrast-enhanced scaned by 320-Slice Spiral CT in three days before opeatation.All the CT images were analyzed in dependently by 2 radiologists who with full experienced without information about gastroscopic surgical or histological results.Location,size and the attenuation values of the lesion and lymph nodes were measured.we also study the imaging features of the lesion,tumor infiltration,lymph-node involvement and organs or lesion metastasis were analyzed.The CT staging and pathological gross type of cancer were included,too.Finally the results were compared with histopathologic findings.The statistically significant level was considered as 0.05.Results1.Gastric cardia cancer patients accounted for 16.2%(11/68)in 68 patients with gastric cancer,13.2%(9/68)for gastric corpus cancer,54.4%(37/68)for antral cancer,and cancer of antrum accounted for 8.8%(6/68),diffuse type for 7.4%(5/68.2.The sensitivity of 320-slice CT in assessing Borrrnann ??? types of gastric cancer are 60.0%?70.0%?52.3%and83.3%,respectively.The specificity are 96.5%?86.5%?88.9%and 88.0%,respectively.The accuracy are 93.5%?83.9%?77.8%and 80.6%.MSCT has higher sensitivity?specificity and accuracy indifferentiation of gastric cancer of Borrmann ?.3.The CT enhancement of gastric cancer is mainly from portal vein to moderately and the peak of enhancement appears at the portal phase.There was no significant difference in mean CT values between the three groups during the plain scan period and the arterial phase.There was a statistically significant difference in mean CT values between the portal venous phase and the balance phase.In the well-differentiated adenocarcinoma group and the moderately-differentiated adenocarcinoma group.There was a statistically significant difference in CT values between the plain scan and the portal vein.In the poorly differentiated adenocarcinoma group.except for the CT value of the portal venous phase and the balance phase,There was no statistically significant difference.The mean CT value of the plain scan and the arterial phase tumors were statistically significant.4.The results of 320-slice CT enhanced scan in the determination of lymph node metastasis in advanced gastric cancer:the lymph node short aspect ratiao?0.5 was used as the criteria for the determination of metastatic lymph nodes,the diagnostic accuracy rate was 60.0%(319/532),and the ratio of the lymphatic aspect ratiao?0.7 for the determination of metastatic lymph nodes criteria,the diagnostic accuracy rate was 86.5%(460/532).The lymph node-enhanced CT differences were used as criteria to determine whether the lymph nodes were metastasized:the accuracy of CT enhancement difference ?60Hu and CT enhancement difference ?90Hu were 67.5%and 76.4%,respectively.The CT findings were in good agreement with the surgical pathology results.The accuracy of CT enhancement difference ?30Hu to determine the metastasis of lymph nodes was 39.7%.The CT findings were consistent with the surgical pathology results.5.The total accuracy of 320-slice CT for diagnosing T-staging is 76.5%.The accuracy of clinical staging of T2-T3 and T4 are 83.3%,71.4%and 86.4%,respectively.6.The accuracy of 320-slice CT for diagnosingN0-N3staging are 80.7%(25/31),88.9%(16/18),87.5%(14/16),33.3%(1/3),respectively.The total accuracy of MSCT for N staging is 82.4%(56/68).7.Compared with pathological results,the total accuracy of 320-slice CT for diagnosing TNM-staging is 59.7%(37/62),and the TNM staging is also in higher accordance with pathological findings(Kappa =0.712,P<0.001).ConclusionThe preoperative evaluation with plain and three phases contrast-enhanced 320-slice CT is helpful in directing clinical therapy of gastric cancer and improving the accuracy of TNM staging of gastric carcinoma.It is also contribute to assess the invasion,metastasis and prognosis of gastric carcinoma.Part? Clinical significance of 320-slice VCT angiography in radical resection of gastric carcinomaObjectiveTo explore the application value of 320 row volume CT angiography combined with the original three phase enhanced scan in displaying gastric peri gastric artery.Materials and methodsA retrospective analysis of 257 consecutive gastric carcinoma patients confirmed by pathology.All of the cases underwent CT scaned by Aquilion ONE 320-Slice Spiral CT.The scanning range was from the diaphragmatic dome to the flat umbilical plane.The three-dimensional images were obtained by using postprocessing workstation.Two imaging diagnostic physicians with over 5 years experience worked together to finish the reading work and reached an agreement.McNemar test(Exact probability method)was adopted to compare the display rate of VR and MIP in the reconstruction of the gastric blood supply artery,P<0.05 was statistically significant.Results1.The directly blood-supplying arteries of the stomach were displayed by 320-slice spiral CT:LGA and RGEA were showed fine by VR and MIP,the display rate was more than 70%,there was no statistically significant difference between them.Arteries distributed in the greater curvature of the stomach,SGA and PGA branches of Splenic artery of the posterior wall of the stomach were displayed poor,the show rate was less than 10%.MIP was limpider than VR in the display of tiny blood vessels.The VR display rate of RGA,LGEA,SGA and PGA was significantly lower than that of MIP,the difference was statistically significant between them.2.Indirectly gastric blood-supplying arteries were thicker,the reconstruction methods of VR and MIP on indirectly gastric blood-supplying arteries(CHA,PHA,GDA and SA)was good,the show rate was 100%(257/257).3.The display of the origin of gastric blood-supplying arteries by VR?MIP reconstruction technique was this group of LGA origin was relatively constant(239/257),the original variation was rare(18/257),the variation rate was 7.0%.RGA original types were more.In 247 display ceases those Originated from CHA were the most common,129 cases,accounted for 52.2%.Cases Originated from RHA and LHA were rare,8 cases and 3 cases,accounted for 3.1%and 1.2%respectively;The percent of LGEA originated from SA was 100%,No case of original variation was found.RGEA and SGA were originated from GDA and SA respectively.Many SA cases were originated from PGA,129 cases in this group totally.4.The variation of gastric peripheral artery and branch of gastric blood supply artery was shown that the number of gastric peripheral and gastric blood-supplying vessels variation cases was 66 in this group,the aberration rate was 25.7%(66/257).The variation of left accessory hepatic artery was the most common,accounted for 9.3%(24/257).The origin variation rate of the replacement of common hepatic artery,splenic artery and left gastric artery was rare,4 cases,accounted for 1.6%(4/257).The number of variation cases of celiac trunk branch vessel was 11,the aberration rate was 4.3%(11/257).Conclusions1.320-MSCTA can clearly display the spatial structure of all major gastric peripheral arteries,explicitly show the adjacency relationship and exactly revel the variation of gastric blood-supplying arteries of gastric cancer.It is advantageous to the selection of operation type and the evaluation of therapeutic effect.2.The display of direct blood-supplying arteries to the stomach is that the show of VR and MIP to the LGA and RGEA is better.The display of VR to SGA and PGA is poor.3.The show of 320 MSCT in the reconstruction of VR and MIP to relatively larger indirect blood-supplying gastric arteries(CHA,PHA,GDA and SA)is fine,the display rate is all up to 100%.4.The display of VR and MIP to the origin of blood-supplying gastric arteries is good,but the show of minute blood vessels in posterior gastric artery and arteriae gastricae breves is poor,so it has certain limitations.Part ?:Value of 320-Slice VCT and CTA in Laparoscopic D2 radical gastrectomy in gastric cancerObjectiveTo evaluate the diagnostic value of 320 slice CT enhanced scan combined with MSCTA in radical mastectomy for gastric cancer D2.Materials and MethodsIn this study,108 cases of gastric cancer D2 total gastrectomy were retrospectively reviewed and analyzed.All Patients were non-randomly divided into 320-slice CT scaning group(n=60)and non-CT scaning group(n=48)Operative time,extent of lymph node dissection,intraoperative blood loss,postoperative hospital stay and complications were compared between the two groups.For CT scaning group,all patients underwent plain CT scanning and contrast-enhanced CT scanning with Auqio ONE 320-slice CT.Application 320-slice CT angiography demonstrate sufficiently the blood vessels around the stomach and the blood supply of the tumor with working station HP ZR 2440W.The statistically significant level was considered as 0.05.Results1.In CT scaning group,the ratio of distal gastrectomy,proximal partial gastrectomy and total gastrectomy are20.0%,58.3%and 21.7%,respectively.In the control group,distal,proximal,and total gastrectomy were performed in 11 patients 22.9%,19 patients 39.6%and 18 patients 37.5%.There was no significant difference between the two grous(P>0.05).2.Operative time 217±24 min VS.289±31min,between the CT scan group and the non-CT scan group were significantly different(P<0.05).The number of lymph nodes dissected 32±3.OVS.29±1.8,between the CT group and the non-CT group was not significantly different(P>0.05).Compared with non-CT group,blood loss in the CT group was less 168(110?600)ml VS.280(150?720)ml,P<0.01.3.Postoperative complications developed in 7 patients in the CT group and in 7 patients in the non-CT group,there was not significantly different(P>0.05).The food taking time 3.1±0.5 dVS.2.8±1.0d,P>0.05.Postoperative hospital stay was shorter(8.6±0.6)d VS.(11.9±1.1)d,the difference was statistically significant between the two groups(P>0.05).4.There were 15cases of artery variation branching around stomach,including 9 cases of CT scaning group and 6 cases of non CT scaning group.The diagnostic concordance rate between MSCTA and intraoperative findings was 100%.Conclusions1.Preoperative 320-slice CT scaning with CTA is benificial to the evaluation of vascular structure of the gastric carcinoma and the adjacent tissues,which may reduce postoperative complications,reduce the blood loss and the operative time,it has a great value for D2 radical total gastrectomy for gastric carcinoma.2?320-MSCTA with three dimensions can clearly display the arteries and the variation arteries arond the stomach,and can provide guidance for laparoscopy-assisted gastrectomy. |
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