小肠恶性间质瘤16例影像学观察及临床病理分析

16 cases of gastrointestinal stromal tumor of small intestine: the comparative study of imaging findings and clinic pathological analysis

目的探讨小肠恶性间质瘤(GIST)的钡餐造影和CT扫描影像学特征及诊断价值。方法分析16例经手术、病理证实的小肠恶性GIST的影像学资料。结果16例中,低度恶性6例,高度恶性10例,肿瘤大小3.2～7.2cm,平均5.6cm。钡餐造影表现为黏膜皱襞变平或破坏、肠腔偏侧性狭窄、肿块内出现钡斑或窦道样改变;CT检查为腔外不规则肿块、肿块内多灶性低密度坏死区、明显的不均匀强化。结论钡餐造影和CT扫描等影像学检查是小肠恶性GIST定位诊断的主要方法;影像学表现具有一定的特征性,沿长轴偏侧性狭窄伴多发性溃疡、不规则腔外肿块、肿块内多处低密度区征象、增强扫描有明显的不均匀强化等对恶性GIST诊断有较大价值。

Objective To evaluate the barium meal radiography and CT scans in diagnosing malignant gastrointestinal stromal tumors （GIST） of small intestine. Methods The clinical and imaging data of 16 patients with GISTs of small intestine which were diagnosed surgically and pathologically were analyzed and summarized. In this group CT scan and gastrointestinal barium exam（GI） was performed. Results The tu- mors included 6 low-malignant GISTs of small intestine and 10 high-malignants. The diameter varied from 3.2 cm to 7.2 cm, the average size was 5.6 cm. The main signs of barium meal of malignant GIST of small intestine included flattened or destroyed mucosa runae, partial lumen stenosis, and barium fleck and fistula in the tumor. On CT scans, the main manifestation was an extraluminal mass with multiple necrosis areas of low density. Conclusion Barium examination and helical CT scan are the major imaging techniques in the determination of the location of GIST of small intestine. The appearance of imperfect lumen and the irregular tumor with multiulcerations or low density regions and inhomoneneous enhancement may lead to the correct diagnosis of malignant GIST.