Diagnosis of the Invasion Depth of Gastric Cancer Using MDCT With Virtual Gastroscopy: Comparison With Staging With Endoscopic Ultrasound
Diagnosis of the Invasion Depth of Gastric Cancer Using MDCT With Virtual Gastroscopy: Comparison With Staging With Endoscopic Ultrasound
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DOI：
10.2214/ajr.10.5872
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发表时间：
2011-10-01
影响因子：
5
通讯作者：
Goto, Hidemi
中科院分区：
文献类型：
--
作者：
Furukawa, Kazuhiro;Miyahara, Ryoji;Goto, Hidemi
客观的。本研究的目的是回顾性评估仅使用MDCT图像生成的虚拟胃镜对胃癌病灶的检出率，以及虚拟胃镜联合多平面重建（MPR）图像增强MDCT（虚拟胃镜+MPR）对胃癌病灶检出率的准确性，并比较MPR图像虚拟胃镜与超声内镜的诊断性能。 材料和方法。受试者包括 175 名患者，总共有 186 个经内镜证实的胃癌病灶。所有患者均接受动态MDCT（动脉期和静脉期）进行术前分期，并接受手术或内镜治疗。在也使用超声内镜检查的 129 名患者（135 个病灶）中，还比较了两种检查方式的 T 分期准确性。两名内窥镜医师独立评估了虚拟胃镜图像上的病变检出率，并利用 MPR 图像确定了虚拟胃镜下的 T 分期。 T 分期包括区分 T1a 和 T1b 病变的能力。 结果。总体病变检出率为67.7%（126/186）。 T1a、T1b、T2及以上的检出率分别为37.8%（28/74）、75.0%（39/52）、98.3%（59/60），差异有统计学意义（p < 0.001）。使用 MPR 图像虚拟胃镜检查的 T 分期准确度为 82.2% (111/135)，使用超声内镜的 T 分期准确度为 83.7% (113/135)，无统计学差异 (p = 0.850)。过度分期和低估的主要原因分别是溃疡或溃疡疤痕和低分化腺癌、非实体型。结论。 MPR 成像虚拟胃镜检查是胃癌 T 分期的一种有用方法。
OBJECTIVE. The objectives of this study were to retrospectively evaluate the lesion detection rate of gastric cancer using only virtual gastroscopy generated from MDCT images and the accuracy of invasion depth diagnosis (T staging) using virtual gastroscopy together with contrast-enhanced MDCT with multiplanar reconstruction (MPR) images (virtual gastroscopy with MPR), and to compare the diagnostic performance between virtual gastroscopy with MPR images and endoscopic ultrasound.MATERIALS AND METHODS. The subjects consisted of 175 patients with a total of 186 endoscopically proven gastric cancer lesions. All patients underwent dynamic MDCT (arterial and venous phase) for preoperative staging and underwent surgery or endoscopic treatment. In 129 patients (135 lesions) who were also examined using endoscopic ultrasound, the T staging accuracy was also compared between the two modalities. Two endoscopists independently evaluated the lesion detection rate on virtual gastroscopy images alone and determined the T stage on virtual gastroscopy with MPR images. The T staging included the ability to differentiate T1a from T1b lesions.RESULTS. The overall lesion detection rate was 67.7% (126/186). The detection rates of T1a, T1b, and T2 or deeper were 37.8% (28/74), 75.0% (39/52), and 98.3% (59/60), respectively, showing statistically significant differences (p < 0.001). The T staging accuracies were 82.2% (111/135) using virtual gastroscopy with MPR images and 83.7% (113/135) using endoscopic ultrasound, showing no statistically significant difference (p = 0.850). The main causes of over-and understaging were an ulcer or ulcer scar and poorly differentiated adenocarcinomas, non-solid type, respectively.CONCLUSION. Virtual gastroscopy with MPR imaging is a useful modality in the T staging of gastric cancer.