| Objective：To explore the value of spectral CT imaging combined with multi-directionadjusting and multi-planar reformation in the preoperative T Staging evaluation ofgastric cancer.Methods:After obtaining the approval from the insititutional ethics committee of the firstaffiliated hospital of zhengzhou university with waiver of informer consent, totallysixty five patients with gastric cancer confirmed by the pathology before theoperation underwent abdominal double-phase enhanced gemstone spectral imagingscanning with Spectral CT from December2012to December2013(49men,16 women, age range22-84years old with median age58.3years old). Main clinicalmanifestation included upper abdominal pain, abdominal discomfort, early satiety andso on. Cardia of stomach30cases, fundus of stomach13cases, body of stomach13cases, antrum of stomach9cases, all the patients were conducted with operation inone to two weeks after the CT examination.The raw data were transmitted to GEAW4.4post-processing workstation to obtain the optimal monochromatic images, andthe axial,coronal,sagittal and multi-direction adjusting and multi-planar reformationwere performed on the conventional kVp images and optimal monochromaticimages,and the multi-direction adjusting and multi-planar reformation images whichcan display the maximum range of the gastric cancer on the same slice were better,then the T staging of gastric cancer were also evaluated according to the differentreconstructed images.Results:Among65patients with gastric cancer,47cases with lower degreedifferentiation,15cases with moderate degree differentiation,9cases with higherdegree differentiation were confirmed by the pathology examination.4cases,12cases,33cases,16cases were diagnosed as T1, T2, T3, T4staging respectively by thepathology examination after the operation. The overall accuracies of axial images,combined axial and coronal images, combined axial and sagittal images, combinedaxial and multi-direction adjusting and multi-planar reformation conventional kVpimages for the evalution of depth of the stomach wall (the T staging) were relevativehigh,78.5%(51/65)、81.5%(53/65)、83.1%(54/65)、87.7%(57/65)respectively; Theoptimal monochromatic axial images combined axial and coronal images, combinedaxial and sagittal images, combined axial and multi-direction adjusting andmulti-planar reformation images also had an higher overall accuracies,80.0%(52/65)、84.6%(55/65)、89.2%(58/65)、92.3%(60/65) respectively.Thediagnostic efficiency were differemt according to which kind of the reformationimages on the T Staging evaluation of differernt parts of the gastric cancer. Conclusion：1. Spectral CT combined with multiple MPR images can further improve theaccuracy of T Staging evaluation of gastric cancer.2. Multi-direction adjusting and multi-planar reformation can be a auxiliary methodfor T Staging evaluation of gastric cancer.3. It is different for the T staging diagnosis of different parts of the gastric cancerwith different reconstruction methods. Objective：To explore the value of spectral CT parameters combined with other factors inthe prediction of stomach wall invasion of gastric cancerMethods:Totally sixty five patients with gastric cancer confirmed by the pathology beforethe operation were included in this retrospective study who underwent abdominaldouble-phase enhanced gemstone spectral imaging scanning with Spectral CT,49men,16women, with median age58.3years old. Main clinical manifestation includedupper abdominal pain, abdominal discomfort, early satiety and so on. Cardia ofstomach30cases, fundus and body of stomach26cases, antrum of stomach9cases,all the patients were conducted with operation in one to two weeks after the CTexamination.The iodine concentration of the lesion and the abdominal aorta artery,the CT value on the70kev monochromatic images on the arterial and venousphase were measured, the NIC on the arterial and venous phase were calculated, andwhether the largest diameter of the primary tumor larger than5cm or not wereevaluated on the multi-direction adjusting and multi-planar reformation images(partone).With the postoperative pathological results as the standard, all the patients weredivided into different groups depending on the different gender, age,location of theprimary lesion, the size of the largest diameter of the primary lesion, degree ofdifferentiation to evaluate the related factors and risk factors.Results:Among65patients with gastric cancer,47cases with lower degreedifferentiation,15cases with moderate degree differentiation,9cases with higherdegree differentiation were confirmed by the pathology examination.4cases,12cases,33cases,16cases were diagnosed as T1, T2, T3, T4staging respectively by thepathology examination after the operation. By compared the accuracy of the serosalinvasion using CT with the postoperative pathological results, male patients, patientswith lower degree differentiation and the largest diameter of the primary tumor largerthan5cm had an revelative higher proportion,64.6%,58.5%and66.2%, respectively.The correlation analysis showed that whether the serosa invaded were related to thegender, degree of differentiation, tumor size of the patients, the difference wasstatistically significant (P<0.05). While the difference of the age,location of the tumorhas no statistically significant. Multi-factor unconditioned Logistic regressionanalysis with the serosa invaded as dependent variable, gender, degree ofdifferentiation, tumor size of the patients, the CT value and the NIC in the arterial andvenous phase as independent variable revealed that the differentiation degree, tumorsize of the patients, the CT value and the NIC in the venous phase were the riskfactors for diagnosing the serosal invasion.Conclusion：1. It is valued that the Spectral CT parameters combined with other factors canpredict of stomach wall invasion of gastric cancer in some extent. 2. Differentiation degree of the stomach, tumor size, the CT value and the NIC inthe venous phase are the risk factors for the evaluation of gastric cancer in thestomach wall invasion. |
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