胃癌CT分期与治疗前评估课件.pptx
胃癌CT分期与治疗前评估Gastric Cancer:CT staging and assessement before treatment,胃癌原发灶CT评价,CT检查流程,禁食空腹 过夜禁食或大于6小时低张药物 10-20mg山莨菪碱气充盈 6g（2包）产气粉平扫水充盈 800-1000ml增强扫描 三期 40s 70s 150s,*Radiology.2007 Feb;242(2):472-82,胃腔扩张不佳及未禁食对诊断的影响,CT检查,气充盈与水充盈,*AJR 2010;195:13161323,CT检查,Fig.239-year-old woman with early gastric cancer(EGC)(pT1a)as seen on gas distention CT scans with IV contrast enhancement.,CT检查,Fig.471-year-old man with early gastric cancer(EGC)(pT1b)as seen on water distention CT scans with IV contrast enhancement,CT检查,Fig.537-year-old woman with advanced gastric cancer(pT3)seen on gas distention CT scans with IVcontrast enhancement.,进展期胃癌的大体形态Borrmann分型,进展期胃癌 Borrmann 1型,进展期胃癌 Borrmann 型,进展期胃癌 Borrmann 型,进展期胃癌 Borrmann 型,CT报告：分期描述,*Eur Radiol(2012)22:654662 reviewer 1 77.2%（98/127）reviewer 2 82.7%（105/127）,T1a（粘膜层）,T1b(粘膜下层),T1b(粘膜下层),T2（肌层）,T2,T3（浆膜下）,T3,T4a（浆膜）,T4b,CT报告,多平面重建,*Radiology.2007 Feb;242(2):472-82.,MPR,T4a？,T4b,T2？,T3,MPR,CT判断胃癌可切除性,癌肿浸润胃左动脉、肝十二指肠韧带、胰腺、肝脏、横结肠、腹主动脉、膈肌、以及伴有远处转移，视为不可切除,*Zilai Pan,Kemin Chen,et al.Eur Radiol(2010)20:613620,CT报告原发灶,胃腔扩张好，胃（底/体/角/窦），（大弯/小弯/前壁/后壁）见胃壁增厚（形成肿块），呈（隆起/凹陷/平坦）形态，粘膜面凹凸不平可见溃疡（深/浅），SSD或CTVE粘膜皱襞集中伴中断增强扫描病变强化区累及深度（低密度条带受累大于或小于1/2），或累及全层，浆膜面（光滑/毛糙/结节状凸起/索条影）胃壁病变与周围脏器关系（脾、肝、胰腺、膈肌，横结肠及系膜）,胃癌淋巴结分组及N分期诊断,淋巴结分组,No.1 right cardiaI 贲门右No.2 left cardiaI 贲门左,No.1,No.2,淋巴结分组,No.3 lesser curvature 胃小弯,第1、3组的分界胃左动脉向胃壁第一分支,No.1 vs 3left gastricartery,No.4 greater curvature 胃大弯4s(left)4sa short gastric artery 胃短动脉 4sb left gastroepiploic artery 胃网膜左动脉 4d(right)right gastroepiploic artery 胃网膜右动脉,淋巴结分组,第2、4sa组的分界APIS 左膈下动脉,APIS-A.phrenica inferior sinistra(left)No.2 vs No.4sa,第2、4sa组的分界APIS 左膈下动脉,AGB-A.gastrica breves(short gastric arteries),AGES-A.gastroepiploica sinistra,No.4sa 4sb,No.4sa 4sb,淋巴结分组,No.4sd right gastroepiploic artery 胃网膜右,No.5 suprapyloric lymph node 幽门上,淋巴结分组,No.5 幽门上淋巴结与胃右动脉,right gastric arteryNo.3 vs No.5,No.5 幽门上淋巴结与胃右动脉,No.6 infrapyloric lymph node 幽门下,淋巴结分组,No.7 left gastric artery 胃左动脉旁（根部）,淋巴结分组,No.8（8a前，8p后）along the common hepatic artery 肝总动脉旁,淋巴结分组,No.9 around celiac artery 腹腔干,淋巴结分组,No.10 splenic hilus 脾门No.11 splenic artery 脾动脉旁,淋巴结分组,No.12 LN in the hepatoduodenal ligament 肝十二指肠韧带 No.12a肝动脉 12b胆总管 12p门静脉,淋巴结分组,No.13 posterior aspect of the pancreas 胰腺后,淋巴结分组,No.14 root of the mesenterium 肠系膜根部,淋巴结分组,No.16 para-aorta 腹主动脉旁,淋巴结分组,胃癌淋巴结转移诊断,*AJR Am J Roentgenol.1999 Aug;173(2):365-7.,长径3-9mm的小淋巴结转移最多，大小与正常淋巴结重叠，单纯径线诊断转移较困难,文献报道CT诊断标准：孤立的淋巴结，长径大于8mm且门脉期CT值大于85Hu簇状淋巴结，或多个孤立的淋巴结呈网格状相连 N分期诊断准确度达78%（43/55）,*Radiology.2007 Feb;242(2):472-82.,淋巴结转移诊断,胃癌N分期诊断,对不同T分期胃癌，使用不同淋巴结径线判断N分期的准确度,greater omentum,transverse mesocolon,posterior peritoneum,mesostenium,hepatogastric ligament,perihepatic peritoneum,腹膜播散,Transverse mesocolon,Greater omentum,关于胃癌报告分期,T分期：CT报告准确度较高（80%左右）N分期：早期胃癌 N分期可信度较高（短径10mm）进展期胃癌 CT判断 N0 与 N+,Thank you,
