| Part ?CT serosa high enhancement sign in differentiating T3 from T4a gastric cancerObjective To analyze the value of serosa high enhancement sign in differentiating T3 and T4a gastric cancer,and to explore the difference of abdominal CT enhanced three-phase scanning in observing serosa high enhancement sign.Methods The CT images of abdominal three-phase enhanced scan in 103 patients with stage T3 or T4a gastric cancer confirmed by operation and pathology were analyzed retrospectively.The occurrence rate of serosa high enhancement sign in each stage was observed and compared.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of serosa high enhancement sign in the diagnosis of T4a stage gastric cancer were calculated by using serosa high enhancement sign as the criterion for the diagnosis of T4a stage gastric cancer.The high enhancement sign of serous membrane in three stage CT images was examined by chi-square test to determine whether there was any difference in the appearance of high enhancement sign of serous membrane in each phase.Results A total of 103 cases of gastric cancer confirmed by operation and pathology were included,including 34 cases of T3 stage and 69 cases of T4a stage.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of serosa high enhancement sign in the diagnosis of stage T4a was 77.67%(80/103),81.16%(56/69),70.59%(24/34),84.85%(56/66)and 64.86%(24/37)respectively.The occurrence rates of serosa high enhancement sign in the arterial phase,venous phase and delayed phase of T4a gastric cancer was 31.88%(22/69),75.36%(52/69)and 62.32%(43/69)respectively.There was significant difference between the arterial phase and the venous phase and between the arterial phase and the delayed phase,but there was no significant difference between the venous phase and the delayed phase.Conclusion The serosa high enhancement sign has high accuracy,sensitivity and specificity in the diagnosis of gastric cancer stage T4a.It can be used to judge the serosa invasion of gastric cancer.It is recommended to observe this sign in the venous or delayed phase.Part ?Diagnostic value of multimodal dual-energy CT parameters in Lauren classification of gastric carcinomaObjective To explore the value of multimodal dual-energy CT(DECT)parameters in preoperative diagnosis of Lauren classification in gastric cancer.Methods A total of 77 patients with gastric cancer confirmed by operation and pathology were collected.The iodine concentration,overlay value,CT values of the lesions were measured in arterial and venous phase DECT images.The difference of CT value between arterial and venous phase was calculated and compared with postoperative pathology.ANOVA was used for statistical analysis.Parameters with statistical significance were used to draw the receiver operating characteristic curve(ROC curve)to evaluate the diagnostic efficacy of each index,respectively.The diagnostic threshold and the area under the AUC(ROC curve)were obtained according to the principle of maximum Youden index.Results The difference of iodine concentration,overlay value of arterial and venous phase and the difference of CT value between arterial and venous phase of gastric carcinoma were diffuse type(1.58±0.44mg/ml,37.56±12.31HU,2.71±0.47mg/ml,64.21±11.92HU,39.78±9.49HU)higher than intestinal type(0.84±0.31mg/ml,22.88±8.04HU,1.51±0.32mg/ml,39.01±6.41HU,20.60±4.76HU)(P<0.05)and mixed type gastric carcinoma(0.94±0.30mg/ml,43.14±6.39HU,1.71±0.26mg/ml,24.41±6.91HU,25.43±6.44HU)(P<0.05),and mixed type higher than intestinal type gastric carcinoma(P>0.05).The arterial iodine concentration,overlay value,venous iodine concentration,overlay value and difference of CT value between arterial and venous phase in the diagnosis of diffuse gastric carcinoma's AUC were 0.904,0.835,0.983,0.970,0.949 respectively,and the diagnostic thresholds were 1.05 mg/ml,31.45HU,2.15 mg/ml,50.35HU,27.50HU.Among them,iodine concentration in venous phase and overlay value in venous phase had the best diagnostic efficiency.Conclusion The iodine concentration,overlay value of arterial and venous phase and the difference of CT value between arterial and venous phase of dual-energy CT is helpful for preoperative evaluation of Lauren classification in gastric cancer,and the diagnostic efficacy of venous iodine concentration is the best.Part ?Clinicopathological analysis of diffuse gastric cancerObjective The clinicopathological features of diffuse gastric cancer were analyzed to provide a basis for clinical rational formulation of treatment plan and evaluation of prognosis.Methods Retrospectively analyzed the clinicopathological data of 200 patients with gastric cancer treated by surgery in our hospital,age,sex,degree of differentiation,nerve invasion,vascular invasion,her-2 expression,tumor maximum diameter,metastatic lymph number,metastatic lymph node ratio,and depth of invasion.According to whether diffuse gastric cancer is divided into diffuse gastric cancer group(103 cases)and non diffuse gastric cancer group(intestinal type,mixed type)(97 cases),the clinicopathological factors of diffuse gastric cancer were analyzed by ?2 test and two-class logistic regression model.Results Of the 200 patients with gastric cancer,123 were male and 77 were female,aged 18-83,with an average of 58.4±10.9 years,and 103 were diffuse gastric cancer(51.5%).The results of univariate analysis showed that age,sex,degree of differentiation,nerve invasion,vascular invasion,Her-2 expression,metastatic lymph number,and metastatic lymph node ratio were the effects of diffuse gastric cancer(P<0.05).Multivariate analysis showed that age(p=0.009,Exp(B)=0.954)was an risk factor for diffuse gastric cancer.Conclusion Diffuse gastric cancer is closely related to age,sex,degree of differentiation,nerve invasion,vascular invasion,her-2 expression,metastatic lymph number,metastatic lymph node ratio,which can be used for further study of clinicopathological characteristics and imaging manifestations and values. |
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