| Objective:A thesis of analyzing and investigating the differences of the enhanced scan between advanced gastric cancer and gastric lymphoma to improve the diagnostic level of gastric cancer, especially the staging of gastric carcinoma and primary lymphoma of gastric.Materials and Methods:A retrospective analysis of enhanced CT manifestations in46cases of advanced gastric cancer and23cases of gastric lymphoma that have proved by pathology, in which gastric cancer T3and T4both were23cases Advanced gastric cancer include ulcerous type39cases (in these disease areas single ulcer34cases and multiple ulcer5cases), infiltrative type5cases and mushroom type2cases; Gastric lymphoma include single ulcer5cases and multiple ulcer18cases in these disease areas. All the patients were pre-treated with abdominal multi-slice spiral CT scan and three phase enhanced scanning. For the enhanced scan, high pressure syringe was applied by intravenous bolus injection in cubital veins of80～100ml non-ionic iodine contrast agent OUSU (lohexol,300mgl/ml) at the speed of3.5ml/s. The scan of arterial phase is at25s after injection,that parenchymal phase is at60s and that equilibrium phase is at180s.After scan was finished, the impages of VR、MIP、MPR were rebuilded and the CT value in disease areas of plain scan and every phase enhancement were measured at the post-processing workstation.And then recording the maximum value of all and observing the pathological changes of mucosa and serosa. CT staging before operation and TMN staging according to the postoperative pathological findings were carried on to the patients who had gastric cancer.At last the statistical study would be undergoing with CT plain scan value, CT enhancement value, CT staging and the character of tumour.Results:1.46patients with gastric cancer and23patients with gastric lymphom showed non-specific gastrointestinal symptoms mainly,such as abdominal pain, abdominal distension; upper gastrointestinal bleeding showed black stool primarily.2. Gastric cancer occurs in the gastric antrum commonly and is often ulcerous type followed by solitary ulcer in this type; primary gastric lymphoma mainly grows in gastric body and gastric antrum,little in cardia and fundus, and often disease areas are followed by multiple ulcers or great tuberosity.3. The enhancement degree of gastric cancer in MSCT enhancement scanning is higher than that of primary gastric lymphoma group,the accuracy rate of preoperative identification between advanced gastric cancer and gastric lymphoma in69patients is91.3%(63/69); the identification of CT enhancement value between advanced gastric cancer and gastric lymphoma have significant differences statistically.4. The coincidence rate of CT staging and TMN staging of advanced gastric cancer in46cases is87.0%(40/46);the CT enhancement value of TMN staging of advanced gastric cancer have significant differences statistically.Conclusion:1. The difference in the enhancement value of MSCT parenchymal phase is beneficial to the differential diagnosis in the gastric cancer of T3staging and T4staging.2. The difference in the enhancement value of MSCT three phases is beneficial to the differential diagnosis between advanced gastric cancer and primary gastric lymphoma.3. Advanced gastric cancer invades perigastric fat spaces more easily than primary gastric lymphoma does. 4. The incidence of stomach wall stiffness, gastric cavity straitness and proximal gastric expansion in advanced gastric cancer is higher than primary gastric lymphoma.5. The CT enhancement can provide the basis for diagnosis and treatment to the clinical practice. |
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