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目的探讨宝石能谱CT诊断胃癌区域淋巴结转移的临床应用价值。方法选取100例胃癌患者,患者术前先经螺旋CT扫描,间隔1个小时后,经宝石能谱CT扫描。观察并记录两组患者宝石能谱CT诊断结果及螺旋CT诊断结果 ,宝石能谱CT上淋巴结长径和淋巴结强化程度不同的诊断结果 ,评价宝石能谱CT诊断胃癌区域淋巴结转移的诊断效果。结果宝石能谱CT诊断胃癌淋巴结转移的敏感度为91.2%(73/80),特异度为90.0%(18/20),诊断符合率91.0%(91/100),螺旋CT诊断胃癌淋巴结转移的敏感度为76.3%(61/80),特异度为55.0%(11/20),诊断符合率72.0%(72/100),当转移性淋巴结长径≥8mm时,与病理诊断结果一致性较高(κ值0.842)。当强化程度差值≥80 Hu时,与病理诊断结果一致性较高(κ值0.856)。结论宝石能谱CT对胃癌转移性淋巴结具有较高的诊断率,特异性和敏感度较高,以淋巴结长径≥8 mm及淋巴结强化密度差值≥80 Hu为诊断淋巴结转移阳性的标准,能提高判断淋巴结是否转移的准确性。
Objective To investigate the clinical value of gem energy spectrum CT in the diagnosis of regional lymph node metastasis of gastric cancer. Methods 100 patients with gastric cancer were selected. The patients underwent helical CT scan before surgery and 1 hour after the surgery. The samples were scanned by gem energy spectrum. The diagnostic results of energy spectrum CT diagnosis, helical CT diagnosis, lymph node long diameter and lymph node enhancement on gem energy spectrum CT were observed and recorded. The diagnostic value of gem energy spectrum CT in the diagnosis of lymph node metastasis of gastric cancer was evaluated. Results The sensitivity, specificity and accuracy of gem spectroscopy in the diagnosis of lymph node metastasis of gastric cancer were 91.2% (91/80), 90.0% (18/20), 91.0% (91/100), respectively. The sensitivity was 76.3% (61/80), the specificity was 55.0% (11/20), the diagnostic coincidence rate was 72.0% (72/100). When the length of metastatic lymph node was ≥8mm, the consistency with pathological diagnosis was High (κ value 0.842). When the difference of enhancement level was ≥ 80 Hu, the consistency with pathological diagnosis was higher (κ = 0.856). Conclusions Gem-energy spectrum CT has a high diagnostic rate, high specificity and high sensitivity for metastatic lymph nodes of gastric cancer. The long diameter of lymph nodes ≥ 8 mm and the difference of enhancement density of lymph nodes ≥ 80 Hu are the criteria for diagnosing positive lymph node metastasis Increase the accuracy of lymph node metastasis.