Value of dynamic enhanced MSCT scanning and serum tumor marker levels in differentiating advanced gastric cancer from gastric lymphoma

FENG Hao; YE Daixi; JI Shengchao

doi:10.3969/j.issn.1674-4136.2024.05.011

Abstract：Objective To evaluate the value of dynamic enhanced multislice spiral CT(MSCT)scanning and serum tumor markers in distinguishing advanced gastric cancer from gastric lymphoma.Methods 21 patients with gastric lymphoma and 87 patients with advanced gastric cancer admitted to The 904th Hospital of Joint Logistics Support Force from March 2014 to March 2023 were selected as the study objects.In the two groups,CT plain scan was performed first,then dynamic enhanced MSCT scan was performed,and the levels of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 125(CA125)were detected.The mucosal condition,extent of gastric wall invasion,degree of gastric cavity stenosis,and enlargement of abdominal and retroperitoneal lymph nodes in patients with gastric lymphoma and gastric cancer were observed and recorded;The CT values of gastric lymphoma and gastric cancer patients on plain scan,as well as the CT values of enhanced three-phase scan,enhanced net increment in arterial and portal phases were recorded;The degree and uniformity of enhancement in patients with gastric lymphoma and gastric cancer were compared;The levels of CEA,CA19-9,and CA125 in patients with gastric lymphoma and gastric cancer were compared.The diagnostic efficacy of CT enhanced net increment and CT combined with tumor markers for gastric cancer and gastric lymphoma was analyzed by ROC curve.Results The number of gastric cancer patients with mucosal white line sign is significantly higher than that of gastric lymphoma patients.The number of gastric cancer patients with mucosal lifting sign,abdominal and retroperitoneal lymph node enlargement is significantly lower than that of gastric lymphoma patients.The range of gastric wall invasion in gastric cancer patients is less than 50％,and the number of gastric cavity stenosis is significantly higher than that of gastric lymphoma patients,with statistical significance(P＜0.05).CT value of arterial stage,portal stage,delayed stage and net increment of arterial stage and portal stage in gastric cancer patients were significantly higher than those in gastric lymphoma patients,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in CT values between two groups on plain scan(P＞0.05).There is a significant difference in the degree and uniformity of enhancement between gastric lymphoma and gastric cancer(P＜0.05).The CEA levels in gastric cancer patients were significantly higher than those in gastric lymphoma patients,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in CA19-9 and CA125 levels between gastric cancer patients and gastric lymphoma patients(P＞0.05).The results of ROC curve analysis showed that the areas under the curve of the enhanced net increment in arterial phases,the enhanced net increment in portal phases,the combination of the enhanced net increment in arterial and portal phases,and the combination of CT and tumor markers in the diagnosis of gastric cancer and gastric lymphoma were 0.829,0.799,0.874,0.938,respectively,and the sensitivities were 0.837,0.816,0.885 and 0.943,respectively.Conclusions In distinguishing advanced gastric cancer from gastric lymphoma,the utilization of MSCT dynamic enhanced scanning and serum CEA levels holds significance.