1、234568癌肿胃壁：僵硬癌肿胃壁：僵硬扩张不良正常胃壁：柔软扩张不良正常胃壁：柔软9T4aT4b10111213142010 2010 胃癌胃癌7th7th分期标准分期标准CTCT征象对照征象对照2011 欧洲放射学欧洲放射学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%15T1:侵至粘膜或粘膜下层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可见粘膜下低密度带不可见：粘膜下低密度带不可见：癌肿厚度需癌肿厚度需 50%全层胃壁厚度全层胃壁厚度,未触及外层稍高强化带未触及外
2、层稍高强化带17T1T1：50%50%50%全层全层18T3:侵至浆膜下侵至浆膜下癌肿与胃壁最外层无分界癌肿与胃壁最外层无分界/累及可分辨的胃壁全层累及可分辨的胃壁全层,且浆膜面光滑且浆膜面光滑19T4a:侵透浆膜至胃周脂肪间隙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 infiltration20T4a新征象新征象:浆膜面浆膜面“亮线征亮线征”T4a21T3T4a22T4bT4b期期:侵犯邻近脏器侵犯邻近脏器肝脏肝脏胰腺胰腺脾脏脾脏结肠结肠“三面环山
3、，一面临水三面环山，一面临水”23T324结节样外侵结节样外侵T4aT4a25T4b：通过脂肪间隙弥漫浸润至胰腺：通过脂肪间隙弥漫浸润至胰腺26可切除可切除不可切除不可切除27窄窗窄窗宽窗宽窗T4aT4a28没有冠、矢状，不要轻易判断浆膜情况没有冠、矢状，不要轻易判断浆膜情况 Radiology 2007Radiology 200729T4aT4a30腹膜增厚腹膜增厚+大量腹水大量腹水网膜饼网膜饼M分期：腹膜转移31早期转移征象的识别“Smudge sign”32轻度轻度中度中度重度重度33横结肠系膜横结肠系膜+少量腹水少量腹水壁腹膜壁腹膜34腹膜转移位置的全面观察35363738正常正常转移
4、转移39normal轻轻中中重重4041胃癌检出腹水胃癌检出腹水50ml50ml，腹膜转移率，腹膜转移率80%80%100%100%Chang DK.Clinical significance of CT-defined minimal ascites in patients with gastric cancer.World J Gastroenterol 2005Yajima K.Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer.Am J Surg 200642
