MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign
MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign
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DOI：
10.1259/bjr.20130290
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发表时间：
2013-09-01
影响因子：
2.6
通讯作者：
Park, D. Y.
中科院分区：
文献类型：
--
作者：
Kim, T. U.;Kim, S.;Park, D. Y.
目的：我们研究的目的是评估CT结果，以区分T4 A和不太先进的gastric cancer.Methods：机构审查委员会批准了这项研究，并放弃知情同意。本研究纳入了228例回顾性确定的手术证实的胃癌患者（138例T1，25例T2，24例T3和41例T4 a），这些患者也接受了术前CT扫描。横向和多平面重建扫描由另外两名设盲的放射科医生一致审查。评价了以下区分T4 a与较不晚期癌症的CT表现：胃壁的结节或不规则外层、胃周脂肪模糊和高密度浆膜征。结果：在单因素分析中，胃壁外层结节状或不规则、胃周脂肪模糊、浆膜高密度征对T4 a与低进展期胃癌的鉴别诊断有显著意义。此外，胃壁外层结节状或不规则形以及高密度浆膜征在T3和T4 a之间的鉴别中具有重要意义。多因素Logistic回归分析显示，高密度浆膜征是T3和T4 a鉴别诊断的最重要指标（比值比4.210; 95%可信区间1.581-11.214; p=0.004）。结论：高密度浆膜征象可能是T4 a和低进展期胃癌鉴别诊断的一个有用的CT表现。高密度浆膜征与胃癌侵犯浆膜有关，有助于制定最佳术前评估和治疗计划。
Objective: The purpose of our study was to evaluate CT findings to differentiate between T4a and less advanced gastric cancers.Methods: The institutional review board approved this study and waived informed consent. This study included 228 retrospectively identified patients with surgically confirmed gastric cancer (138 T1, 25 T2, 24 T3 and 41 T4a) and who had also undergone pre-operative CT scan. Transverse and multiplanar reconstruction scans were reviewed in consensus by two other blinded radiologists. The following CT findings that differentiate T4a from less advanced cancers were evaluated: nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and a hyperattenuating serosa sign. The CT features of T4a and less advanced gastric cancers were compared by means of univariate and multivariate analyses.Results: In univariate analysis, nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and the hyperattenuating serosa sign were significant in differentiation between T4a and less advanced gastric cancers. In addition, nodular or an irregular outer layer of the gastric wall and the hyperattenuating serosa sign were significant in differentiation between T3 and T4a. In multivariate logistic analysis, the hyperattenuating serosa sign was the most significant finding in differentiation between T3 and T4a (odds ratio, 4.210; 95% confidence intervals, 1.581-11.214; p=0.004).Conclusion: The hyperattenuating serosa sign may be a useful CT finding in differentiation between T4a and less-advanced gastric cancers.Advances in knowledge: The hyperattenuating serosa sign is associated with gastric cancer with invading the serosa and can facilitate planning of the optimal pre-operative evaluation and treatment.