中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (10): 808-811.

• 专题笔谈 • 上一篇    下一篇

残胃癌的影像学诊断

张晓鹏，唐 磊   

  1. 北京大学临床肿瘤学院 北京肿瘤医院暨北京市肿瘤防治研究所医学影像科，北京100142
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-10-01 发布日期:2009-10-01

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-10-01 Published:2009-10-01

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摘要：

X 线气钡双对比造影及CT、MRI 检查是残胃癌主要的影像学评价手段，涉及的领域包括检出、精确分期、辅助手术、术后随访及疗效评价等多个方面。残胃癌X 线造影诊断时应注意辨识“假肿瘤征”和“假龛影征”，CT、MRI高分辨成像及MRI 扩散加权成像可辅助残胃癌的检出。CT 和MRI 是常用的影像学分期手段，结合轴、冠、矢状位三平面观察癌肿浸润深度及与邻近结构的关系，T 分期准确率可达85%以上水平。残胃周围可由于纤维瘢痕、静脉充血等原因导致索条或脂肪间隙密度增高，应结合浆膜面形态判断以防止T3 过估。评价残胃癌淋巴结应注意手术导致的淋巴引流改变，并结合增强扫描区分手术导致的胃周及大血管周围的纤维化团块。结合全面的生物学行为影像指标建立数理模型是提高残胃癌N 分期的关键。CT 血管造影可辅助术前对残胃周围供血动脉及变异的评价，有助于安全、快速的手术。对于无法手术切除的残胃癌，CT和MRI 可作为有效的评价手段，对姑息化疗效果进行跟踪评价。

关键词: 残胃癌, 影像学诊断, 龛影, 淋巴结转移

Abstract:

Imaging diagnosis of gastric stump carcinoma ZHANG Xiao-peng, TANG Lei. Department of Imaging, Peking University School of Oncolocy, Beijing Institute for Cancer Research, Beijing 100142, China Corresponding author: ZHANG Xiao-peng, E-mail: zxp@bjcancer.org Abstract X-ray double contrast imaging, CT and MRI are the main evaluation modalities of gastric stump carcinoma (GSC). The clinical applications include detection, staging, operation assistance, follow-up and therapeutic effect evaluation.“Fake-tumor sign”and“fake niche sign”should be aware during X-ray double contrast imaging of GSC. CT and MRI high-resolution imaging and diffusion-weighted MR imaging can be helpful in the detection of GSC. CT and MRI are the most useful staging modalities. The accuracy of T staging could reach 85% or more after combined ax-, cor- and sag- planes. The density of para-stomach fat space could increase or with strands because of the fibrous scar and venous congestion. The morphology of serosa should be taken into consideration in case of T3 over-evaluation. The change of lymph drainage caused by operation should be aware during the evaluation of lymph node metastasis. The enhanced imaging should be preformed to discriminate the fibrous lumps around remnant stomach or large vessels from lymph nodes. The key to improve the N-staging level is to build the artificial intelligence model combining full-scale biological behavior index. CT angiography can be used to help the pre-operation evaluation of feeding arteries of remnant stomach, and their variants also, which can contribute to safe and high-performance operation. CT and MRI can be used in the evaluation of therapeutic effect of chemotherapy in GSC .

Key words: gastric stump cancer；imaging diagnosis；niche sign, lymph node metastasis