螺旋CT扫描对胃肠道间质肿瘤的诊断及其病理分析

Diagnosis of gastrointestinal stromal tumor using spiral CT,as well as pathological analysis

目的探讨胃肠道间质肿瘤(GIST)的螺旋CT影像学特征及诊断价值。方法回顾病理明确诊断的81例GIST临床及CT等影像学资料。结果81例中,良性24例,恶性57例。肿瘤大小0.5～17.0cm,平均6.8cm。病灶位于胃50例,小肠22例,直肠结肠6例,肠系膜3例,4例伴肠系膜淋巴结转移。良性GIST螺旋CT显示一般小于2cm、密度均匀、边缘无分叶、界限清楚、均匀强化;若大于5cm、腔外不规则或长分叶状肿块、界限不清、明显的多灶性低密度坏死区、增强扫描明显的不均匀强化则多为恶性。结论CT是胃肠道间质肿瘤定位诊断的主要影像学方法。消化道偏侧性狭窄伴溃疡、不规则腔外肿块、多灶性低密度区、明显的不均匀强化等征象对恶性GIST定性诊断有较大价值。

Objective To probe value of CT findings in diagnosing gastrointestinal stromal tumor(GIST).Methods Clinical and CT data of 81 patients with GISTs that were confirmed surgically and pathologically were retrospectively reviewed.Results Among 81 cases,24 were benign and 57 malignant.The tumor diameter varied from 0.5cm to 17cm,with an average of 6.8 cm.50 cases had tumors in stomach,22 in small intestine,6 in colon or rectum,3 in mesentery,and 4 invaded to lymph nodes of mesentery.Benign lesions of GISTs were characterized on CT by smaller than 2cm,even density,no lobulation,sharply demarcated,and evenly enhanced;while malignant ones featured larger than 5cm,irregular mass beyond lumen or lobulated mass,blurred demarcation,multi-focal hypointensity due to necrosis,and obviously uneven enhancement.Conclusion CT plays a vital part in diagnosing GIST.The following features strongly suggest malignant lesions:par-tial narrowness in digestive duct accompanied by ulcer,irregular mass beyond lumen,multi-focal hypointensity,and obvious uneven enhancement.