（医学课件）胃癌影像诊断

胃癌影像学评估,纵向增厚,轴向增厚：肿块,基本征象:胃壁增厚,2,假性增厚: 扩张不良正常胃壁,3,BT-4胃癌,4,多平面重建MPR: 轴+冠+矢,5,6,基本征象: 腔内溃疡,8,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,基本征象: 浆膜外侵 & 脏器浸润,T4a,T4b,10,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,粘液腺癌,基本征象: 泥沙样钙化,12,粘液腺癌,13,胃癌影像学分型分期: T分期,14,2010 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,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,16,T2: 侵至固有肌层,癌肿 50%全层胃壁厚度, 未触及外层稍高强化带,17,T1： 50%全层,T2： 50%全层,18,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,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,T4a新征象: 浆膜面“亮线征”,T4a,21,T3,T4a,22,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,T3,？,24,结节样外侵,T4a,？,25,T4b：通过脂肪间隙弥漫浸润至胰腺,？,26,可切除,不可切除,？,27,窄窗,宽窗,宽窗显示脂肪间隙内结构,T4a,28,29,T4a,30,腹膜增厚 +大量腹水,网膜饼,M分期：腹膜转移,31,早期转移征象的识别,“Smudge sign”,32,轻度,中度,重度,“污迹征”,33,横结肠系膜+,少量腹水,壁腹膜,34,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,大网膜（胃结肠韧带GCL）,36,横结肠系膜,37,肝胃韧带,38,后腹膜,正常,转移,39,小肠系膜,normal,轻,中,重,40,肝周被膜,41,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 pat