| Objective: To discuss the MDCT manifestations and thickness of the normal gastroesophageal junction by measuring and observing the lower esophagus, GEJ, and stomach fundus with MDCT and its reformated techniques.Materials and Methods:Twenty normal volunteers aged from 37 to 70 underwent 64-slice spiral CT from May 2009 to March 2010. The volunteers were received muscle injection of 654-2(20-40mg) before CT scanning, then drank water of 1000ml orally,100ml lotus root starch and 100ml of water successively for controlling the vermicular motion of stomach. All scans were obtained with 64-slice spiral CT(GE Lightspeed VCT64).Image acquisition and reconstruction parameters for CT scanner was as follows:tube voltage of 120KV, tube current of 100mA,section thickness of 64×0.625mm,per rotation times of 0.35s and FOV of 370-400mm.Images of MPR and CPR were obtained by using 1mm slice thickness. All volunteers underwent contrast-enhanced CT scanning with 90ml vol. contrast medium administered intravenously and at a rate of 3ml/sec.The arterial phase scanning performed in 30s after injection and the portal venous phases in 60s, delayed phases in 2min.Then the thickness of lower esophagus, GEJ, stomach fundus was measured, the mean and standard deviation were calculated as well.Results:The thickness of the lower esophagus, GEJ and stomach fudus was 2.37±0.72mm,5.82±0.48mm,3.01±0.69mm respectively.Conclusion:MDCT with its reformated techniques can reveal the manifestations of GEJ combined with coronal and oblique sagittal view. The thickness of GEJ can be measured accurately so as to lay a foundation for diagnosis of carcinoma of GEJ. The good preparation of lower tension is more useful to observe the structure of GEJ. The left phrenic angle is almost on the same horizon of Z-line of GEJ. Objective:To evaluate the value of preoperative TNM staging and classification with MDCT and its reformated techniques. And provide important information to the treatment as well.Materials and Methods:The data of 40 GEJ carcinoma patients aged from 37 to 81 undergone 64-slice spiral thoracoabdominal CT scan were analyzed retrospectively. By defining the left phrenic angle as the Z-line and according to the Siewert's criterion, the distance was measured as the classification, and the TNM staging was determined as well. Those findings of MDCT were compared with surgico-pathological results as the golden reference.Results:All 40 cases were confirmed by surgico-pathological results.There are 5 cases of typeⅠ,18 cases of type II, and 17 cases of type III. The sensitivity and specificity of type I,II,III were 80% (4/5),88.9%(16/18),88.2% (15/17) and 97.1%(34/35),86.4%(19/22),95.6%(22/23) respectively.There are 4 cases of T1-2(10%),15 cases of T3 (15%), and 30 cases of T4(75%). The sensitivity and specificity of T1-2, T3, T4 by MDCT examination were 75% (4/5),66.7%(4/6),86.%(26/30) and 94.4%(34/36),88.2(30/34)%,90.0%(9/10) respectively.On MDCT imaging, metastatic lymph node was diagnosed as it's diameter >10mm with vague contour and inhomogenous enhancement. The sensitivity and specificity were 59.4%(19/32) and 88.9%(8/9).The accuracy of M stage is 100% for thoracoabdominal area.Conclusion:MDCT technique can provide an objective and effective criteria in determing the classification and preoperative TNM staging for patients with GEJ carcinoma. Objective:To demonstrate feeding arteries of GEJ carcinoma with MPR, VR, and CPR's techniques of MDCT.Materials and Methods:Forty GEJ carcinoma patients aged from 37 to 81 undergone 64-slice spiral thoracoabdominal CT scan from May 2009 to March 2010 in our hospital were analyzed retrospectively. Feeding artery of GEJ carcinoma was displayed by using the VR, MPR and CPR techniques. Then frequency and degree of visualization of visualization considered in statistics.Results:mostly Left gastric artery (LGA) is the feeding artery of GEJ carcinoma in majority cases. There were 2 cases with extra feeding artery which is originated from phrenic artery. Visualization rates of LGA were 92.5%,97.5% and 50% on VR, MPR, CPR images respectively. There was significant difference in the frequency and degree of visualization of LGA among MPR,VR and CPR. Namely MPR and VR were superior to CPR in the visualization of LGA. MPR was superior to CPR and VR in the visualization of phrenic artery.Conclusion: Reformated images is better to reveal the feeding arteries and blood supply in GEJ carcinoma, and could be helpful to clinicians and patients as if the artery infusion of chemotherapy and interventional embolization were recommended. |
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