探讨伴有肝转移的胃肝样腺癌（HAS）患者的增强多层螺旋CT（MSCT）特征。

回顾性分析2013年2月至2022年2月在郑州大学第一附属医院经病理确诊的8例HAS患者，8例患者均行腹部增强CT扫描，其中4例为术前（胃癌根治术）检查。男6例，女2例，中位年龄64岁。分析病灶影像学参数，包括动脉和静脉期的增强模式、坏死情况、静脉是否有血栓以及整体影像学诊断。

胃部病灶位于胃底和贲门4例（4/8，50%）、胃窦3例（3/8，37.5%）、胃底1例（1/8，12.5%）。分析4例术前胃部病灶图像，胃壁最大厚度为（22.02±3.64）mm，大体类型表现为隆起型2例、溃疡型1例、浸润型1例。肿瘤平扫呈软组织密度肿块，2例见低密度坏死区，4例均未见钙化。动脉期3例明显强化，1例中度强化。2例可见由于瘤内坏死引起的不均匀强化。8例HAS肝转移灶中6例为多发，2例为单发。轴位MSCT示7例患者最大肝转移癌灶>3 cm，且无论大小均可见坏死。6例癌灶边界清楚。增强强化不均匀，3例表现为环形强化。动脉期轻度强化6例，中度强化2例，呈典型"快进快出"模式。7例伴淋巴结转移，3例伴门脉侵犯，1例伴胰腺转移。

胃部原发癌灶MSCT典型表现为胃壁增厚>2 cm的软组织密度肿块，可伴有坏死，罕见钙化，增强扫描见中度至明显持续性强化。肝转移灶增强MSCT表现类似于原发性肝癌，但是患者常无肝癌易患因素，且瘤灶坏死率高。此外，常合并腹腔内、胃周淋巴结肿大，部分可合并腹部其他器官如胰腺转移。

To investigate the enhanced multislice spiral CT (MSCT) features of hepatoid adenocarcinoma of the stomach (HAS) with liver metastasis.

Eight cases of histologically proven HAS between February 2013 and February 2022 in The First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. All 8 patients underwent contrast-enhanced abdominal CT scanning, of which 4 were preoperative radical gastrectomy. There were 6 males and 2 females, with a median age of 64 years. Imaging parameters were analyzed, including enhancement mode of arterial and venous phases, necrosis, venous thrombosis and overall imaging diagnosis.

The gastric lesions were located in the fundus of stomach and cardia (4/8, 50%), antrum of stomach (3/8, 37.5%) and fundus of stomach (1/8, 12.5%). Preoperative images of 4 gastric lesions were analyzed. The maximum thickness of gastric wall was (22.02±3.64) mm, and the general types were protuberance type in 2 cases, ulcer type in 1 case and infiltration type in 1 case. The tumor showed soft tissue density mass on plain scan, and 2 cases showed low density necrosis area. No calcification was found. In arterial phase, 3 cases showed obvious enhancement, 1 case showed moderate enhancement, and 2 cases showed uneven enhancement due to intra-tumor necrosis. Among the 8 cases of HAS liver metastases, 6 cases were multiple, and 2 cases were single. Axial MSCT showed that the largest liver metastases in 7 patients were > 3 cm, and necrosis was visible regardless of size. The boundaries of the cancer lesions were clear in 6 cases. The reinforcement was uneven, and 3 cases showed ring reinforcement. There were 6 cases of mild reinforcement in the arterial phase and 2 cases of moderate intensification, typical "fast forward and fast out" mode. There were 7 cases with lymph node metastasis, 3 cases with portal vein invasion and 1 case with pancreatic metastasis.

The typical MSCT manifestation of primary gastric cancer is a soft tissue density mass with gastric wall thickening >2 cm, which may be accompanied by necrosis and rare calcification. Enhanced scanning shows moderate to obvious continuous enhancement. The enhanced MSCT findings of liver metastases are similar to primary liver cancer (HCC), but patients often have no risk factors for HCC, and the tumor necrosis rate is high. It is often complicated with lymph node enlargement in abdominal cavity and around stomach, and some of them may be complicated with other abdominal organs such as pancreatic metastasis.