OBJECTIVETo investigate the value of CT perfusion imaging in differential diagnosis between Borrmann types II( and III( gastric cancer.

METHODSAll the patients were proven as ulcerated gastric cancer by preoperative gastroscopy and underwent CT perfusion scanning with Aquilion ONE 320 spiral CT from October 2013 to June 2014 in The First Affiliated Hospital of Zhengzhou University, including 19 patients as Borrmann type II( gastric cancer and 23 patients as Borrmann type III( gastric cancer by pathology. Lesions were divided into three parts by two tangent lines perpendicular to the gastric wall of the ulcer edge, including proximal part (close to cardia), ulcer part and distal part (close to pylorus). All the perfusion images were analyzed in the Toshiba 4.7 post processing workstation. Blood flow (BF), blood volume (BV), and clearance (CL) were measured according to Patlak-plot mode, and arterial flow (AF) was measured according to Single-input maximum mode. Differences in all the parameters between Borrmann type II( and III( groups were analyzed. Receiver operating characteristic (ROC) curve was used to determine the threshold of perfusion parameters for differentiating Borrmann type II( and III( gastric cancer.

RESULTSThere were no significant differences in AF, BV and BF of ulcer part between the two groups (all P>0.05). While the CL of ulcer part in Borrmann type III( group was (7.17±2.41) L/s, which was significantly higher than (4.82±2.26) L/s in Borrmann type II( group (P=0.00). There were no significant differences for all the parameters at proximal part and distal part between the two types (all P>0.05). According to the ROC curve, area under the curve of CL was 0.78. Taking 0.59 L/s as the threshold of CL value, the corresponding sensitivity and specificity for diagnosing Borrmann type III( were 70% and 80%, respectively.

CONCLUSIONThe CL value has certain diagnostic value in differential diagnosis between Borrmann types II( and III( gastric cancer.