胃癌影像诊断.ppt

1、胃癌影像学评估,北京大学肿瘤医院 医学影像科 2014.4.11,a,2,纵向增厚,轴向增厚：肿块,基本征象:胃壁增厚,a,3,假性增厚: 扩张不良正常胃壁,a,4,BT-4胃癌,a,5,多平面重建MPR: 轴+冠+矢,a,6,a,8,基本征象: 腔内溃疡,a,9,基本征象: 胃壁僵硬,癌肿胃壁：僵硬,扩张不良正常胃壁：柔软,a,10,基本征象: 浆膜外侵 & 脏器浸润,T4a,T4b,a,11,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,

2、a,12,粘液腺癌,基本征象: 泥沙样钙化,a,13,粘液腺癌,a,14,胃癌影像学分型分期: T分期,a,15,2010 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%,a,16,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,a,18,T1： 50%全层,a,19,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,

3、 且浆膜面光滑,a,20,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,a,21,T4a新征象: 浆膜面“亮线征”,T4a,a,22,T3,T4a,a,23,T4b期:侵犯邻近脏器,肝脏,胰腺,脾脏,结肠,“三面环山，一面临水”,a,24,T3,？,a,25,结节样外侵,T4a,？,a,26,T4b：通过脂肪间隙弥漫浸润至胰腺,？,a,27,可切除,不可切除,？,a,

4、28,窄窗,宽窗,宽窗显示脂肪间隙内结构,T4a,a,29,a,30,T4a,a,31,腹膜增厚 +大量腹水,网膜饼,M分期：腹膜转移,a,32,早期转移征象的识别,“Smudge sign”,a,33,轻度,中度,重度,“污迹征”,a,34,横结肠系膜+,少量腹水,壁腹膜,a,35,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,a,36,大网膜（胃结肠韧带GCL）,a,37,横结肠系膜,a,38,肝胃韧带,a,39,后腹膜,正常,转移,a,40,小肠系膜,normal,轻,中,重,a,41,肝周被膜,a,42,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