胃肠间质瘤的CT诊断及治疗评价

CT diagnosis and treatment evaluation in gastrointestinal stromal tumor

目的:探讨胃肠间质瘤(GIST)的CT表现及分子靶向药物甲磺酸伊马替尼(STI571)对胃肠间质瘤疗效的CT评价。方法:选择经手术及病理证实的胃肠间质瘤病例32例进行回顾性分析。对19例接受STI571治疗者进行定期CT检查随访,观察病灶大小、形态及密度变化,评价药物疗效。结果:32例GIST中,发生于胃部的18例,小肠11例,肠系膜1例,直肠2例。①CT特征:恶性度较高的胃肠间质瘤CT表现为:肿块相对较大,密度不均,肿瘤中央坏死及囊变多见;肿瘤边缘多不光整,可呈分叶状。增强扫描肿瘤呈不均匀强化;少数巨大肿瘤密度较低,极少数可见高密度出血及钙化灶。良性GIST体积较小,密度均匀,肿瘤坏死及囊变少见,病灶边缘光整,增强扫描多呈均匀强化;②19例接受STI571治疗者定期CT检查疗效评价为(肿瘤缩小):疗效达PR(部分缓解)者9例,占47.4%,疗效为SD(疾病稳定)者8例,占42.1%,病灶进展(PD)者2例,占10.5%。术后2年内复发及转移者19例。结论:①螺旋CT扫描是诊断胃肠间质瘤最常用和最有价值的影像检查手段,其定位诊断率达81%以上;②应用CT扫描观察测量病灶变化是评价药物(STI571)治疗胃肠间质瘤疗效最重要和最直接的方法之一;对指导临床治疗具有重要意义。

Objective：To explore CT in gastrointestinal stromal tumor（GIST） and evaluation the GIST treated with molecular targeted drug Imatinib mesylate（STI 571） by CT.Methods：A total of 32 cases with GIST confirmed pathologically were retrospectively analyzed. 19 cases treated with SIT571 were followed by CT scanning regularly to oheerve changes in size, shape and density of lesions and evaluate effects, Results：Among total 32 eases of GIST, there were 18 originated from stomach and 11, 1, 2 from small bowel, mesentery, and rectum, respectively. ① CT characteristics： malignant GISTs mainly qualified as large size, inequable density, necrosis and cystoid changes in the center, unsmoothing and lobulated border lines, inequable reinforcement after enhanced CT scanning. A few large malignant tumors appeared as low density, scarce visible bleeding and calcification. While benign GISTs mainly appeared as small size, equable density, smoothing border lines and equable reinforceraont after enhanced CT scanning; ② Response rates in 19 pts treated with STI57 evaluated by CT scanning regularly were as follows： 9/19（47.4%） PR, 8/19（42.1% ） SD, and 2/19（ 10.5% ） PD. 19 cases were relapsed or metastasized after operation in 2 yesrs. Conclusion： ① Spiral CT scanning is the most useful and evaluable method to diagnose the GIST in imagelogy, whose localized diagnosing rate isabove 81%; ② CT scanning is one of the most important and direct method to evaluate response of GIST treated with SIT571, which has significant meaning in guiding clinical therapy.