| Objective: Gastric cancer is one of the problems plaguing human disease. And accurate preoperative staging of gastric cancer before surgery department for selecting appropriate treatment has a decisive influence. Currently Clinically, the proportion of four patients with gastric cancer is significantly undervalued, preoperative imaging assessment accurate screening to avoid stomach cancer metastasis(M1) is pointless exploration is particularly important. Preclinical evaluation of the application of MSCT preoperative staging of gastric cancer has been widely used. However, the evaluation of lymph node metastasis stations such as D3, M1 problems with liver metastases, peritoneal metastasis MSCT accuracy is not satisfactory. Although laparoscopic peritoneal metastasis were able to some extent, but for other aspects of the relatively weak. The magnetic resonance(MR) has some characteristics: MR compared with MSCT ability to distinguish soft tissue; MR are noninvasive; MR does not produce radiation and other medical sources. This study in gastric multi-center clinical trial in patients with advanced gastric cancer foundation MSCT on routine screening, identification of M1 has some difficult cases targeted for MR examination and comparison with MSCT explore MR before surgery to assess progress Gastric M staging advantages for clinical more accurate preoperative assessment of advanced gastric provide a theoretical basis.Methods: Collect Fourth Hospital of Hebei Medical University, 2014.2-2015.2 conform "neoadjuvant chemotherapy for advanced gastric cancer." Phase III clinical trials(project number NCT01516944: advanced gastric cancer perioperative chemotherapy efficacy and safety open, randomized clinical observational studies) Standard Progress 369 cases of gastric cancer patients. Siemens conventional second-generation dual-source dazzle speed multislice spiral CT scanner row MSCT plain and enhanced scan, and three-dimensional reconstruction, preoperative imaging evaluation. By the two experienced radiologists read the piece together, for the evaluation of suspected M1 were a total of 52 cases in three days the line 3.0T superconductive MRI Scanners(3.0THD, Germany’s Siemens company) underwent plain + enhancement + DWI checks. By the same two doctors read the piece together, and radiological assessment to be excised M1 cases do not meet the set criteria. The diagnosis 3.0T MRI diagnosis and MSCT were analyzed, and this simple test group of patients with previous exploratory laparotomy rate ratio were compared. Clinical evaluation(stages using 2010 International Union Against Cancer / American Joint Committee on Cancer(UICC / AJCC) TNM staging criteria): D3 lymph nodes metastasis of gastric cancer(liver duodenum ligament, pancreas, mesenteric root and aortic lymph node metastasis); gastric cancer liver metastases; peritoneal metastasis of gastric cancer; other types of distant metastasis is not included in the trial study.Results:1 D3 station for lymph node metastasis in 15 cases analyzed. MRI diagnosis of 12 cases, MSCT diagnosis of eight cases. By comparing before and after chemotherapy, lymph nodes to determine whether changes in D3 station 6 cases of lymph node metastasis: MRI staging coincidence was 83.3%(5/6), MSCT staging the rate was 66.7%(4/6).2 For analysis of 20 cases of liver metastasis. MRI diagnosis of 15 cases, MSCT diagnosis nine cases. Puncture through the liver pathology or diagnostic probe confirmed a total of five cases: MRI staging coincidence was 100%(5/5), MSCT staging the rate was 60%(3/5).3 Transfer 17 cases analyzed for peritoneal implants. MRI diagnosis of 12 cases, MSCT diagnosis seven cases. Diagnostic laparoscopy confirmed by a total 13 cases: MRI staging coincidence rate 84.6%(11/13), MSCT staging the4 In this study, the preoperative evaluation and exploration rate simply not consistent: while assessing the use of MRI and MSCT was 3.5%(13/369), if only MSCT, the exploration rate will reach 7.6%(28/369).Conclusions:1 MSCT can find the lymph nodes and measure its length, short diameter, for it can not determine whether or not lymph node metastasis, MRI can identify whether the transfer of signals by dynamic contrast-enhanced scan length; for MSCT indistinguishable from normal lymph nodes and surrounding soft tissue, MRI imaging can by dynamic contrast-enhanced scan to identify long signal.2 In the case of liver metastases,if MSCT can not determine, MRI can determine the length of dynamic contrast-enhanced scan signals; for MSCT images indistinguishable from normal liver tissue metastases, it can be identified by the diffusion-weighted imaging signal of MRI.3 For MSCT images indistinguishable from normal peritoneal metastasis and soft tissue, MRI can judge by scan length of dynamic contrast-enhanced signal discrimination.4 For MSCT suspected lymph node metastasis, liver metastasis, peritoneal metastasis that can not be diagnosed, underwent MRI before surgery contribute to accurate staging, especially M stage, thereby reducing clinical unexpected exploration not consistent with the preoperative. |
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