The Comparative Study Between Substation And Staging Of Regional Lymph Nodes Metastasis With MSCT In Gastric Carcinoma

Objective: To study MSCT in the regional lymph node metastasis ofgastric carcinoma (gastric cardia, gastric body and antrum) of the Nsub-station and N staging evaluation, aimed at finding a more accuratepreoperative evaluation of lymph node metastasis of gastric cancer beforesurgery in order to further improve the level of judgment and providing morevaluable information for clinical preoperative and select a reasonable procedurefor the surgical treatment.Materials: Collected in our hospital from January2009to January2011,For gastric cancer underwent surgical treatment of45patients by endoscopicbiopsy confirmed gastric carcinoma (gastric cardia, gastric body and antrumevery part with15cases),30cases were Male patient，15were Female age40-88years, mean age58.2years, all patients were hypotonic MSCT plain andenhanced scans.Methods: CT scan were performed using German Siemens dual-sourceCT, with supine position. All the subjects, who had been fasting for6~8hoursbefore examination, were intramuscular injected654-220mg and drank800~1000ml warm water10minutes before the scan. Scan range: During thenon-contrast scanning, arterial phase and venous phase, it ranges from thelower esophagus to the lower levels of kidney, including the entire stomach,while during the balance phase it ranges from diaphragmatic dome to thecavitas pelvis. Then venous channel was established through the antecubitalvein, non-ionic contrast media Ultravist350, whose iodine content was3.0mg/land total dose was80-100ml, was injected by automatic high pressure injectorat a speed of3ml/s and. The delayed time of arterial phase, venous phase and balance phase were respectively29s、35s and80s.The slice thickness is5mm, and slice distance is also5mm. The originalscanning data was reconstructed with1mm thickness and then transmitted tothe workstation (ADW4.2). With Lymph nodes diagnostic criteria (diameter≥8mm; or the average value difference of enhanced density≥80Hu;or shortdiameter ratio≥0.7), the lymph nodes metastasis pattern of the N staging andsub-station in gastric carcinoma at different location were observed by thecombination of the axial images and MPR reconstruction images. All thepatients were implemented the resection of all or part of stomach after the CTexamination. The Excision of lymph nodes were classified and sent topathology. Analysis by the software SPSS17.0.With the Kappa test method toevaluate MSCT diagnosis of gastric and pathological diagnosis of metastaticlymph node consistency of results.Results: MSCT assessment the single part of the gastric carcinoma(gastric fundus, gastric body and antrum) of regional lymph node metastasisof the N sub-station and N stage and pathological lymph node N sub-stationand N staging contrast, the results show that lymph node metastasis, Nsub-station significantly better than N staging, N sub-station of CT andpathological with excellent consistency (fundus, gastric body and gastricantrum Kappa values were0.889,1.000,1.000). Therefore,in this study，MSCTfor the assessment the regional lymph node metastasis of single part of gastriccarcinoma，N sub-station as the determine the diagnostic criteria was morereasonable.Conclusion: MSCT in the part of assessment regional lymph nodemetastasis of gastric carcinoma, N substation is superior to the traditionalnumber of N staging, especially for the occurrence of lymph node skipmetastases and lymphatic drainage area can provide accurate information forclinical operation and focus of the lymph nodes clean.