胃癌影像诊疗

,*,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,假性增厚,:,扩张不良正常胃壁,BT-4,胃癌,多平面重建,MPR:,轴,+,冠,+,矢,基本征象,:,腔内溃疡,基本征象,:,胃壁僵硬,癌肿胃壁：僵硬,扩张不良正常胃壁：柔软,基本征象,:,浆膜外侵,&,脏器浸润,T4a,T4b,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,粘液腺癌,基本征象,:,泥沙样钙化,粘液腺癌,胃癌影像学分型分期,:T,分期,2023,胃癌,7th,分期原则,CT,征象对照,2023,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】,分期精确性：,77.2%and 82.7%,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,T1,：,50%,全层,T3:,侵至浆膜下,癌肿与胃壁最外层无分界,/,累及可辨别旳胃壁全层,且浆膜面光滑,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,T4a,新征象,:,浆膜面,“,亮线征,”,T4a,T3,T4a,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,？,结节样外侵,T4a,？,T4b,：经过脂肪间隙弥漫浸润至胰腺,？,可切除,不可切除,？,窄窗,宽窗,宽窗显示脂肪间隙内构造,T4a,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,分期精确率提升,10%-20%,Radiology 2023,T4a,腹膜增厚,+,大量腹水,网膜饼,M,分期：腹膜转移,早期转移征象旳辨认,“Smudge sign”,轻度,中度,重度,“,污迹征,”,横结肠系膜,+,少许腹水,壁腹膜,大网膜,横结肠系膜,后腹膜,小肠系膜,肝胃韧带,肝周被膜,腹膜转移位置旳全方面观察,大网膜（胃结肠韧带,GCL,）,横结肠系膜,肝胃韧带,后腹膜,正常,转移,小肠系膜,normal,轻,中,重,肝周被膜,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 2023,Yajima K.Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer.Am J Surg 2023,注重胃癌,CT,检出腹水对分期旳影响,Thank You!,