MSCT Staging Diagnosis Of Gastrocolonic Cancer And The Feasibility Of Laparoscopic Excision

[Objective]1. To retrospectively analyze the MSCT imaging features and stages of gastrocolonic cancer compared with their pathologic manifests.2. To discuss the innovation and dependability of the application of MSCT examination in the diagnosis of gastrocolonic cancer.3. To discuss the feasibility of preoperatively evaluate the resectability and preferable operation method of gastrocolonic cancer.4. To provide more integrated and direct instructional information for laparoscopic excision of gastrocolonic cancer.[Materials and Methods]1. ObjectsPart one: From January 2008 to January 2009, CT and clinic records of 30 patients with pathologically confirmed gastric carcinoma were retrospectively analyzed in this study.Part two: From January 2008 to January 2009, CT and clinic records of 56 patients with pathologically confirmed colon carcinoma were retrospectively analyzed. From November 2008 to April 2009, ten colon carcinoma patients admitted in the Nanfang Hospital were prospectively assessed before operation.2. EquipmentGE Light Speed 16 spiral CT scanner, MEORAO company's high-pressure syringe, GE ADW 4.2 workstation3. Pre-scanning preparationPart one: All 30 gastric carcinoma patients should be on empty stomach for at least 8-12 hours and took 800ml oral solution (30ml contrast agent diluted into 770ml boiled water) before CT scanning. Any kinds of barium examination were not permitted one week before the scanning.Part two: All 66 colon carcinoma patients should be on empty stomach for at least 12 hours before scanning and be on full bladder during scanning. On the day before examination, all 66 colon carcinoma patients took 800ml oral solution separately at 3:00pm. On the check day, all 66 patients were given cleansing enema. Of 56 patients with pathologically confirmed colon carcinoma, 150ml clyster (7ml contrast agent, 143ml physiological saline solution) was used for retention enema. Of 10 patients with colonoscopy suggested colon carcinoma, 800-1200ml (40ml contrast agent, 1160ml physiological saline solution) clyster was used for retention enema based on their tolerance.Contrast agent: 300mg I/ml ultravist or 300mg I/ml Iohexol.4. Scanning methodsPart one: Upper abdominal non-enhanced scanning and dual-phase enhanced scanning. 5 cases of patients with abdominal aortic CTA scan, 3 cases of patients considered with hepatic hemangioma with delay scan.Scanning range: from the lower edge of sternum handle to the inferior pole of kidney.Part two: Retrospectively collected 56 cases of patients with conventional abdominal plain scan and enhancement scan, slice thickness 7.5 mm. After November 2008 ten cases of patients were underwent conventional abdominal scan and dual-phase enhancement scan. Scan parameters: line real time tracking scanning in arterial phase, 60 ~ 70s venous phase, ulnar vein injection, flow rate 4.0 ml / s, 300 mg I / ml Iohexol 80～100 ml, 120 kV, 280mA, slice thickness 5 mm, in enhancement scan reconstruction image slice thickness 1.25 mm, reconstruction interval 0.8 mm. Scanning range: from diaphragmatic dome to the lower edge of pubic symphysis.5. Data processing and image analysisPart one: 30 cases of gastric cancer imaging were analyzed, CT features including the tumor site, thickness of gastric wall, involved range, density, fat space, other organs involvements, distant metastasis, and so on.Part two: 66 cases of colon cancer imaging were analyzed, including the tumor site, shape, size, density, intestinal fat space, lymph node metastasis or distant metastasis, enhancement characteristics. Based on the original analysis, after November 2008 the 10 patients' original data was send to independent workstations provided by GE company for different image post-processing, such as multi-direction or multi-planar reconstruction (MPR), curved planar reconstruction (CPR), vascular reconstruction (VR) . Multiple images of colon cancer combined for analyzed the deep and range of infiltration, the length of involved bowel, the relationship between the lesions and the surrounding tissues or organs, vascular involvement, lymph node metastasis or distant metastasis and so on.Both parts of imaging data was analyzed respectively, two advanced doctor checking it.6. Statistics analysisThe consistency analysis of MSCT staging, operation and pathology result of gastrocolonic cancer were used Kappa test, SPSS13.0 software package. The sensitivity and specificity of MSCT diagnose and staging about colon carcinoma chorion infiltration were computed. The crosstabs were used Kappa test and sensitivity and specificity computed. P<0.05 the difference has statistical significance. Kappa values: less than 0.4 low consistency, 0.4-0.7 moderate consistency, greater than 0.7 high consistency.[Results]Part one:1. Gastric carcinoma CT features was mainly gastric wall thickening, gastric antrum was predilection site, lymph node metastasis was the main gastric cancer diffusion mode. 93% of patients in this group were confirmed lymph node metastasis by pathology.2. In MSCT staging diagnosis, T stage coincidence rate was 86.2%, Kappa value 0.772, with a strong consistency, N period 79.3%, Kappa value, 0.561, with a moderate consistency.3. Of 30 cases of patients, surgery 20 cases,accounts for 66.7%, laparoscopic excision 10 cases, accounts for 30%.MSCT staging of gastric cancer have a higher guiding role in the clinical treatment of gastric cancer and laparoscopic resection.Part two:1. Of 66 cases of patients, surgery 41 cases, accounts for 62.1%, laparoscopic excision 23 cases, accounts for 34.8%.Good bowel preparation was a prerequisite for high-quality images. Compared with conventional MSCT examination, improved bowel preparation and MSCT examination of colon cancer was more conducive to positioning, qualitative, diagnosis staging and preoperative guidance.2. Colon cancer could occur at any part of the colon. Sigmoid colon cancer accounted high percentage. The contour of colon cancer could be divided into ulcer type, mass type, annular thickening type, extensive infiltration of the intestinal wall and intestinal stenosis type, and so on. Colon cancer could occur lymph node metastasis or distant metastasis. Liver metastasis was one of the most common in distant metastasis. The sensitivity of MSCT diagnosis to colon cancer was 86.1%. sensitivity was 95.7%. The sensitivity and specificity of colon cancer serosal surface infiltrating was respectively 90.87% and 95.7%. MSCT diagnose cancer TNM staging has strong consistency with postoperative pathology.3. In various kinds of reconstruction ways, MSCT multiplanar reconstruction (MPR) could observe around the lesion and the relationship between the tissues and organs by omnidirectional, multi-angle, arbitrary planar, combined with cross-sectional images could know tumor size, shape, surrounding organizations adhesions, distant organ or lymph node metastasis. Contour reconstruction could bent the intestine straightly, accurately display the degree of bowel wall thickening and lesions involving length of the intestine, and deplete some false-positive. Intestinal 3D reconstruction could accurately show the tumor site, involving the scope of the narrow and degree of stenosis, combined with CTA images also could assess the relationship between tumor and blood vessels, indicate the scope of bowel involvement and peripheral vascular blood supply and involvement.4. MSCT with high scanning speed, high temporal resolution, low respiratory artifact, multi-phase enhanced scanning simultaneously and rapid continuous scanning characteristics, could easily carry out on the entire lesion observation in the whole arterial phase and venous phase. High spatial resolution could boost the accuracy of the tumor preoperative staging. Powerful postprocessing technologies could provide clinicians accurate, three-dimensional, visual information, and provide more important guiding role in the preoperative evaluation of tumor, treatment selection of the judge of prognosis.[Conclusions]Part one:1. MSCT could clearly show the stomach cavity, wall thickness and the relationship of surrounding organs, the tumor size, shape and the relationship of neighboring structures, lymph node location, size and quantity could be more comprehensive and accurate observation, with high value in gastric cancer diagnosis.2. MSCT could better carry out preoperative TNM staging, reliably judge the feasibility of surgery or laparoscopic excision in gastric carcinoma, guide the choice of surgery plan, and more reliablely evaluate the possibility of carcinectomy and the prognosis.3. MSCT in laparoscopic excision in gastric carcinoma has obvious guiding significance.Part two:1. Improved MSCT examination was a feasible and effective method of examination. It could better carry out the preoperative staging of colon cancer, have a higher value of clinical application in the assessment of laparoscopic resection of colon cancer. 2. MSCT was not only able to make a specific diagnosis of colon cancer, but also make more accurate judgments of lymph node metastasis or distant metastasis.3. MSCT with high scanning speed, time and spatial resolution, powerful post-processing techniques could make better choices for the feasibility and colon cancer surgical resection ways, and for laparoscopic colon cancer resection providing more detailed information. MSCT has a high clinical application value.4. MSCT examination could provide visible and integrity imaging data for clinical diagnosis and treatment about colon cancer, a comprehensive and objective guiding surgeon to selection scientific methods, and should be as a routine clinical examinations in preoperative patients with colon cancer.