团队的力量 Strength of our team！湘雅医院2008级五年制临床医学、麻醉医学及口腔七年制18组同学合作完成本文的翻译Double-Contrast Upper Gastrointestinal Radiography: A Pattern Approach for Diseases of the StomachAbstractThe double-contrast upper gastrointestinal series is a valuable diagnostic test for evaluating structural and functional abnormalities of the stomach. This article will review the normal radiographic anatomy of the stomach. The principles of analyzing double-contrast images will be discussed. A pattern approach for the diagnosis of gastric abnormalities will also be presented, focusing on abnormal mucosal patterns, depressed lesions, protruded lesions, thickened folds, and gastric narrowing.This article presents a pattern approach for the diagnosis of diseases of the stomach at double-contrast upper gastrointestinal radiography. After describing the normal appearance of the stomach on double-contrast barium studies and the principles ofdouble-contrast image interpretation, we will consider abnormal surface patterns of the mucosa, depressed lesions (erosions and ulcers), protruded lesions (polyps, submucosal masses, and other tumors), thickened folds, and gastric narrowing. 上消化道双重对比造影：一种用于胃部疾病诊断的成像方法摘要上消化道双重对比造影系列是用于评估胃部结构性和功能性病变的一种极有价值的诊断方法。
本文将回顾胃部正常解剖的影像学表现，探讨双重对比造影图像分析的原则。
文中还介绍了一种胃部病变的诊断方法，该法侧重于观察异常的黏膜形状，凹陷性的病变、突出性的病变、增厚的黏膜皱襞和消化道的狭窄。
本文阐述了一种通过上消化道双重对比造影诊断胃部疾病的方法。
在描述双重对比造影中胃的正常表现和双重对比造影图像分析原则后，我们将关注胃粘膜表面的异常形态，凹陷性的病变（糜烂和溃疡）、突出性的病变（息肉、黏膜下的块状物和其他肿块）、增厚的黏膜皱襞和消化道狭窄。
NORMAL STOMACHGastric Configuration and Rugal Folds The normal stomach is a J-shaped pouch that lies in the left upper quadrant (Fig 1). The stomach has a fixedconfiguration created by the greater length of the longitudinal muscle layer on its greater curvature. The lesser curvature of the stomach is suspended from the retroperitoneum by thehepatogastric ligament, a portion of the lesser omentum. The gastrosplenic ligament and gastrocolic ligament (ie, the proximal portion of the greater omentum) are attached to the greater curvature of the stomach. The gastric cardia is attached to the diaphragm by the surrounding phrenoesophagealmembrane.Figure 1: Normal stomach. Double-contrast spot image of stomach with patient supine shows distal gastric body (B) and antrum (A). Greater curvature (white arrows) and lesser curvature (black arrows) are coated by barium. Rugal fold on posterior wall of gastric body is depicted as tubular, slightly undulating, radiolucent filling defect (black arrowheads) in shallow barium pool. Dense barium pool outlines contour (white arrowheads) of gastric fundus 正常胃 胃的外形与皱襞 正常的胃位于左上腹，形似J 型嚢袋（图1），胃固定的形态是由胃大弯上较长的纵向肌层形成的。
胃小弯通过小网膜的一部分--肝胃韧带悬挂在腹膜后腔内。
胃脾韧带和胃结肠韧带（即大网膜近端）连于胃大弯上。
胃贲门通过其周围的隔食管膜连于隔上。
图1： 正常胃：病人取仰卧位进行双重对比造影可以显示远端的胃体（B）和胃窦（A）。
胃大弯（白色箭头所示）和胃小弯（黑色箭头所示）均覆盖有一层钡剂。
射线透过钡池较浅的胃体部，能显示出胃体后壁的粘膜皱襞，呈管状、细小的波浪形的充盈缺损。
胃底部（F）钡池稠密，勾勒出胃底的轮廓（白色小箭头所示）。
胃底的粘膜表面和皱襞被稠密的钡池掩盖而不易看见，胃窦部无皱襞。
(F). Mucosal surface and folds in fundus are obscured by barium pool, and antrum is devoid of rugal folds.cardiac “rosette” (Fig 2) (1,2). The gastric fundus is defined as the portion of the stomach craniad to the gastric cardia. The gastric body is defined as the portion of the stomach extending from the gastric cardia to the smooth bend in the mid lesser curvature known as the incisura angularis. The gastric antrum is defined as the portion of the stomach extending from the incisura angularis to the pylorus (a structure created by a muscle sphincter shaped like a figure eight). Figure 2: Double-contrast spot image of gastric fundus with patient in right-side-down position shows normal gastric cardia with smooth folds radiating to central point (white arrow) at closed gastroesophageal junction, also known as cardiac rosette. Long, straight fold (arrowheads) extends inferiorly from cardia along lesser curvature. Black arrows denote normal extrinsic impression by adjacent spleen. Rugal folds are most prominent in the gastric fundus and body, whereas the gastric antrum is often devoid of folds (Fig 1). Gastric rugae are changeable贲门“玫瑰花形”（图2）（1,2） 胃底是指胃贲门入口水平线以上的部分。
胃小弯中断转弯处称为角切迹，胃自贲门至角切迹的部分称为胃体。
胃窦指从角切迹至胃幽门（一个由括约肌组成的“8”字形结构）的部分。
图2 在病人的仰卧水平右侧位胃底的双对比造影点片上，可观察到正常的胃贲门有很多光滑的皱襞，这些皱襞呈放射性的指向（大白箭头）中间胃食管连接部即贲门瓣的位置。
小白箭头指的是直接从贲门延伸到胃小弯的纵行皱襞，黑箭头则为邻近的脾压迫胃所产生的压迹。
胃皱襞大部分突起于胃底和胃体，胃窦通常是没有皱襞的（图1）。
胃皱襞由粘膜层和粘膜下层组成（3,4），这些皱襞在胃小弯部比较直，在胃大弯部则呈波浪形。
胃皱襞的厚structures composed of mucosa and submucosa (3,4). The rugal folds are relatively straight on the lesser curvature of the stomach but larger and more undulating on the greater curvature. The thickness of the rugal folds varies with the degree of gastric distention (5).Areae Gastricae The mucosal surface of the stomach consists of flat polygonal-shaped tufts of mucosa, known as areae gastricae, separated by narrow grooves (6,7). The areae gastricae are recognized on double-contrast studies as a reticular network of barium-coated white lines when barium fills the grooves between these mucosal tufts (Fig 3). Individual mucosal tufts of areae gastricae normally have a diameter of 2–3 mm in the gastric antrum and of 3–5 mm in the gastric body and fundus (Fig 3) (6,8). Areae gastricae are detected on double-contrast studies in nearly 70% of patients and are observed with greater frequency in the elderly (8,9). Figure 3: Double-contrast spot image of stomach with patient in left posterior oblique position shows normal areae gastricae pattern in antrum as 2–3-mm polygonally shaped radiolucent tufts of mucosa outlined by barium in grooves. 度随胃膨胀的程度而变化（5）。