胃癌影像诊断课件

,Page,*,Page,*,Page,*,Page,*,Page,*,Page,*,Page,*,整理ppt,*,胃癌影像学评估,北京大学肿瘤医院,医学影像科,2014.4.11,胃癌影像学评估北京大学肿瘤医院 医学影像科,纵向增厚,轴向增厚：肿块,基本征象,:,胃壁增厚,2,整理ppt,纵向增厚轴向增厚：肿块基本征象:胃壁增厚2整理ppt,假性增厚,:,扩张不良正常胃壁,3,整理ppt,假性增厚:3整理ppt,BT-4,胃癌,4,整理ppt,BT-4胃癌4整理ppt,多平面重建,MPR:,轴,+,冠,+,矢,5,整理ppt,多平面重建MPR:轴+冠+矢5整理ppt,6,整理ppt,6整理ppt,胃癌影像诊断课件,基本征象,:,腔内溃疡,8,整理ppt,基本征象:腔内溃疡8整理ppt,基本征象,:,胃壁僵硬,癌肿胃壁：僵硬,扩张不良正常胃壁：柔软,9,整理ppt,基本征象:胃壁僵硬癌肿胃壁：僵硬扩张不良正常胃壁：柔软9整,基本征象,:,浆膜外侵,&,脏器浸润,T4a,T4b,10,整理ppt,基本征象:浆膜外侵&脏器浸润T4aT4b10整理ppt,基本征象,:,高强化,&,延迟强化,动脉期,(40s),静脉期,(80s),动脉期,(40s),静脉期,(80s),正常,EGJ,癌,动脉期：,血供情况,&Cap,密度,静脉期,:,对比剂癌性,间质空隙内,潴留情况,11,整理ppt,基本征象:高强化&延迟强化动脉期(40s)静脉期(80,粘液腺癌,基本征象,:,泥沙样钙化,12,整理ppt,粘液腺癌基本征象:泥沙样钙化12整理ppt,粘液腺癌,13,整理ppt,粘液腺癌13整理ppt,胃癌影像学分型分期,:T,分期,14,整理ppt,胃癌影像学分型分期:T分期14整理ppt,2010,胃癌,7th,分期标准,CT,征象对照,2011,欧洲放射学,by JW Kim,et al.,两名观察者盲法、独立评价，,2D,（,MPR,各向同性观察）与,3D,（仿真内镜）技术结合,【40min】,分期准确性：,77.2%and 82.7%,15,整理ppt,2010 胃癌7th分期标准CT征象对照2011 欧洲放射学,T1:,侵至粘膜或粘膜下层,粘膜下低密度带可见,粘膜下低密度带不可见：,癌肿厚度需,50%,全层胃壁厚度,未触及外层稍高强化带,17,整理ppt,T2:侵至固有肌层癌肿 50%全层胃壁厚度,17整理,T1,：,50%,全层,18,整理ppt,T1：T2：18整理ppt,T3:,侵至浆膜下,癌肿与胃壁最外层无分界,/,累及可分辨的胃壁全层,且浆膜面光滑,19,整理ppt,T3:侵至浆膜下癌肿与胃壁最外层无分界/累及可分辨的胃,T4a:,侵透浆膜至胃周脂肪间隙,A nodular outer margin of the outer layer and/or a dense band-like perigastric fat infiltration,1.,索条毛刺状外侵,2.,结节样外突,3.,弥漫浸润,20,整理ppt,T4a:侵透浆膜至胃周脂肪间隙A nodular oute,T4a,新征象,:,浆膜面,“,亮线征,”,T4a,21,整理ppt,T4a新征象:浆膜面“亮线征”T4a21整理ppt,T3,T4a,22,整理ppt,T3T4a22整理ppt,T4b,期,:,侵犯邻近脏器,肝脏,胰腺,脾脏,结肠,“,三面环山，一面临水”,23,整理ppt,T4b期:侵犯邻近脏器肝脏胰腺脾脏结肠“三面环山，一面临水”,T3,？,24,整理ppt,T3？24整理ppt,结节样外侵,T4a,？,25,整理ppt,结节样外侵T4a？25整理ppt,T4b,：通过脂肪间隙弥漫浸润至胰腺,？,26,整理ppt,T4b：通过脂肪间隙弥漫浸润至胰腺？26整理ppt,可切除,不可切除,？,27,整理ppt,可切除不可切除？27整理ppt,窄窗,宽窗,宽窗显示脂肪间隙内结构,T4a,28,整理ppt,窄窗宽窗宽窗显示脂肪间隙内结构T4a28整理ppt,没有冠、矢状，不要轻易判断浆膜情况,结合,MPR,三平面图像后,T,分期准确率提高,10%-20%,Radiology 2007,29,整理ppt,没有冠、矢状，不要轻易判断浆膜情况 结合MPR三平面图像后T,T4a,30,整理ppt,T4a30整理ppt,腹膜增厚,+,大量腹水,网膜饼,M,分期：腹膜转移,31,整理ppt,腹膜增厚+大量腹水网膜饼M分期：腹膜转移31整理ppt,早期转移征象的识别,“Smudge sign”,32,整理ppt,早期转移征象的识别“Smudge sign”32整理ppt,轻度,中度,重度,“,污迹征,”,33,整理ppt,轻度中度重度“污迹征”33整理ppt,横结肠系膜,+,少量腹水,壁腹膜,34,整理ppt,横结肠系膜+少量腹水壁腹膜34整理ppt,大网膜,横结肠系膜,后腹膜,小肠系膜,肝胃韧带,肝周被膜,腹膜转移位置的全面观察,35,整理ppt,大网膜横结肠系膜后腹膜小肠系膜肝胃韧带肝周被膜腹膜转移位置的,大网膜（胃结肠韧带,GCL,）,36,整理ppt,大网膜（胃结肠韧带GCL）36整理ppt,横结肠系膜,37,整理ppt,横结肠系膜37整理ppt,肝胃韧带,38,整理ppt,肝胃韧带38整理ppt,后腹膜,正常,转移,39,整理ppt,后腹膜正常转移39整理ppt,小肠系膜,normal,轻,中,重,40,整理ppt,小肠系膜normal轻中重40整理ppt,肝周被膜,41,整理ppt,肝周被膜41整理ppt,胃癌检出腹水,50ml,，腹膜转移率,80%,100%,Chang DK.Clinical significance of CT-defined minimal ascites in patients with gastric cancer.World J Gastroenterol 2005,Yajima K.Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer.Am J Surg 2006,重视胃癌,CT,检出腹水对分期的影响,42,整理ppt,胃癌检出腹水50ml，腹膜转移率80%100%重视胃癌C,Thank You!,Thank You!,