CAJ | 학술논문

目的探讨高场强MRI在胃癌术后复发诊断中的应用价值及临床意义.方法选择胃癌术后患者43例.其中,胃癌术后复发组33例,均经过消化道钡餐、CT、手术或胃镜活检和病理检查确诊;对照组10例,均经胃镜活检及病理检查证实无复发.MRI检查前使用低张剂,服用水做为阴性对比剂,应用1.5TMR快速扰相梯度回波序列、快速恢复自旋回波序列、扩散加权成像、真稳态进动快速序列等及动态增强扫描检查方法.结果 MRI诊出胃癌术后复发患者30例.对照组残胃壁厚度(4.5±0.3)mm,吻合口胃壁厚度(6.3±1.4)mm;复发组残胃吻合口胃壁增厚＞8mm者30例,吻合口邻近胃壁厚度＞5 mm者19例,吻合口软组织肿块并邻近胃壁增厚者11例,肝脾胰腺等周围脏器转移者5例,肝胃之间、腹腔、腹膜后淋巴结转移者9例,病灶在动脉期不均匀强化者9例,静脉期及平衡期病灶呈渐进性、延迟强化者30例.结论 MRI较好地显示了残胃壁及吻合口胃壁的厚度,能够准确判断肿瘤浸润深度、是否与周围组织有毗邻关系以及是否有淋巴结和腹腔内脏器转移等,可以用来指导临床手术方案的选择或综合治疗,对提高胃癌术后生存率具有重要的临床意义.
목적 탐토고장강MRI재위암술후복발진단중적응용개치급림상의의.방법 선택위암술후환자43례.기중,위암술후복발조33례,균경과소화도패찬、CT、수술혹위경활검화병리검사학진;대조조10례,균경위경활검급병리검사증실무복발.MRI검사전사용저장제,복용수주위음성대비제,응용1.5TMR쾌속우상제도회파서렬、쾌속회복자선회파서렬、확산가권성상、진은태진동쾌속서렬등급동태증강소묘검사방법.결과 MRI진출위암술후복발환자30례.대조조잔위벽후도(4.5±0.3)mm,문합구위벽후도(6.3±1.4)mm;복발조잔위문합구위벽증후＞8mm자30례,문합구린근위벽후도＞5 mm자19례,문합구연조직종괴병린근위벽증후자11례,간비이선등주위장기전이자5례,간위지간、복강、복막후림파결전이자9례,병조재동맥기불균균강화자9례,정맥기급평형기병조정점진성、연지강화자30례.결론 MRI교호지현시료잔위벽급문합구위벽적후도,능구준학판단종류침윤심도、시부여주위조직유비린관계이급시부유림파결화복강내장기전이등,가이용래지도림상수술방안적선택혹종합치료,대제고위암술후생존솔구유중요적림상의의.
Objective To evaluate the clinical application of high-field-strength magnetic resonance imaging to diagnose recurrent gastric cancer. Methods Forty three postoperative patients with gastric carcinoma were divided into two groups. The group with recurrent gastric carcinoma has 33 patients, they were clinically confirmed by barium meal of alimentary canal, CT or pathological results. There were 10 cases in control group confirmed by pathological results. All the subjects took hypotonicity agent, followed by water as negative contrast medium. Then patients underwent magnetic resonance imaging including fast spoiled gradient recalled T1WI, T2WI, diffusion weighted imaging, fast imaging employing steady state sequence, magnetic resonance cholangiopancreatographyand dynamic contrast enhancement sequences when gastrointestinal tract was in hypotonic, patients drank or were primed with water as contrast. Results Thirty patients were diagnosed as recurrent gastric cancer with MRI, 28 of them were confirmed by clinical results. Three patients were missed and two patients were incorrectly misdiagnosed by MRI. Wall thickness of gastric remnant was (4.5±0.3) mm and that of stomas was (6.3±1.4) mm in control group. Types of lesions were found on MRI: thickening of remnant stomach stomas was more than 8 mn(n=30), thickening of neighbor rem-nant stomach stomas was more than 5mm (n=19), mass of stomas (n=11), metastasis of neighbor viscus (n=5), and metastasis of lymph nodes (n=9). On enhancement scan, 9 patients showed inhomogeneous enhancement in arterial phase and 30 patients showed gradual delayed enhancement in venous phase and equilibrium phase. Conclusion MRI is an effective imaging method in illustrating wall thickness of gastric remnant and stomas, invasion depth by carcinoma, relationship with neighbor tissue structures and metastasis of lymph nodes and abdominal viscus. It plays an important role in directing clinical therapy.