Dual-phase Contrast-enhanced CT To Evaluate Anastomotic Stoma After Esophagectomy Of Esophageal Carcinoma

Objective:1.To summarize the enhanced MDCT appearances of Anastomotic recurrence after Esophagectomy of esophageal carcinoma.2.To explore the related factors of anastomotic recurrence after Esophagectomy of esophageal carcinoma.Method:Have a retrospective analysis of the enhancement MDCT scan document of 74 cases(50 male and 24 female;aged 44~81 years;the mean age was 63.7±7.6 years,the median age was 64.39 years;The interval from surgery was 1 months ~8 years,the mean time was 28.39±27.22 months,the median time was 19.27 months)of postoperative esophageal cancer proved by endoscopic pathology.It is divided into 3 groups according to CT sign and pathological results: Normal anastomosis group(n1=28),anastomotic benign thickening group(n2=22)and anastomotic malignant thickening group(n3=24).Do a comparative analysis on relevant signs of three groups.Multidetector CT(MDCT)was performed using Toshiba Aquilion ONETM 320 slice CT.To begin with nonenhanced CT(120kV,200 m As,thickness 5mm,spacing 5mm).Then the arterial phase CT scanning coccurred 10 s after a threshold of 200 Hounsfield units(HU)was detected in the descending aorta(ROI),following bolus injection of contrast agent(50~80ml,Iopromide 300mgI/ml),and 40 s was the venous phase CT scanning.All data were acquired with 1mm slice thickness transmitted to workstations Vitrea FX Version 6.3 for MPR(muti-planner reformation),coronal and sagittal reconstruction thickness were 5mm.SPSS19.0 statistical software was used to analyze the data,a of P value less than 0.05 was considered statistically significant.Analysis the anastomotic thickening of benign and malignant relevance to CT features.Analysis the anastomotic thickening of benign and malignant relevance to CT features by A one-way ANOVA and Pearson or Spearman correlation coefficient.Chi square test was used to analyze the factors of age,sex,pathological type,primary tumor site,differentiation degree,T stage,N stage and clinical stage of single factor analysis,multivariate analysis using logistic.Result:1.The thickness of the wall of normal anastomosis,anastomotic benign thickening and anastomotic malignant group difference was statistically significant(P<0.05),the threshold of the wall thickness in anastomotic benign and malignant thickening group was 17.2mm,the sensitivity was 68.2% and the specificity was 93.3%.2.Mucosal disruption in the narrow segment is relatively high,r=0.58(eccentric thickening,lumen mass,inhomogeneous enhancement,irregular upper and lower edge of pipe wall of thickening,mucosal disruption in the narrow segment,arterial phase enhancement amplitude are have certain relevance with malignant thickening of the anastomosis),while thickening of the wall of the ring and the enhancement of venous phase have no statistical significance to the identification of benign and malignant thickening.The correlation coefficient r of arterial phase enhancement amplitude was 0.45.The threshold of the arterial phase enhancement amplitude in the anastomotic benign and malignant thickening group was 19.09 Hu,the sensitivity was 72.7%,and the specificity was 80.0%.3.N staging and clinical stage Ⅲ were associated with anastomotic recurrence.The OR values were 16.500 and 13.200,respectively.Conclusion:1.The enhancement MDCT has higher clinical value to the diagnosis of postoperative anastomotic recurrence of esophageal carcinoma.2.N staging and clinical stage Ⅲ were independent risk factors for anastomotic recurrence.