多层CT小肠造影对小肠胃肠道间质瘤诊断价值

Role of multiple detectors CT enterography in diagnosis of small bowel gastrointestinal stromal tumor

目的评价多层CT小肠造影(MDCTE)对小肠胃肠道间质瘤(GIST)的诊断价值和造影方法对诊断的影响。方法回顾性分析经病理学和免疫组织化学证实的14例单发小肠间质瘤口服2.5%等渗甘露醇MDCTE的肿瘤表现和造影方法。结果所有14例肿瘤瘤体CT值35～41Hu,其中良性肿瘤5例密度均匀,潜在恶性2例和恶性密度不均匀7例。良性肿瘤呈圆形或椭圆形,界线清楚;潜在恶性略呈分叶状,界线清楚,密度不均匀;恶性呈椭圆形或不规则形,与周围组织无明确分界,瘤内见局限性低密度单发坏死区2例,多发坏死区5例。瘤体边缘黏膜面见小切迹(溃疡)2例,其中良性和恶性肿瘤各1例。双期增强扫描良性肿瘤动脉期明显增强3例,静脉期持续明显强化;潜在恶性2例为不均匀性增强,静脉期持续强化。静脉期增强扫描良性肿瘤2例明显均匀增强,恶性7例为不均匀性增强。结论MDCTE简单易行,患者易于接受。根据小肠GIST在MDCTE的形态学、密度、增强变化可为判定肿瘤良或恶性提供有价值信息,但对不典型病例须术后追踪。

Objective To evaluate role of multiple detectors CT enterography （MDCTE） in diagnosis in small bowel gastrointestinal stromal tumors （GIST）. Methods Findings and method of MDCTE in 14 cases with single small bowel GIST were analyzed retrospectively. The patients with GIST confirmed by pathology and immunohistochemistry took orally 2. 5% isoosmia mannitol before MDCTE. Results CT values in parenchyma regions of all 14 cases were from 35 to 41Hu. Five benign neoplasms were of homogenous density and appeared spherical or oval and sharply-marginated. Two potential malignant neoplasms and 7 malignant neoplasms were of heterogenous density, potential malignant neoplasms appeared slight lobulated and sharply marginated while malignant neoplasms appeared oval or irregular and blurred marginated. Two cases had single necrosis region and 5 cases had multiple necrosis regions in malignant neoplasms. The notches, ulcer on the mucosa side of the neoplasms were found in 2 cases, on benign neoplasm and on malignant neoplasm, respectively. Five cases were performed double phased enhanced scan. Three benign neoplasms appeared conspicuous enhancement in arterial phase, and continue enhancement in venous phase. Two potential malignant neoplasms appeared inhomogeneous enhancement in arterial phase, and continue enhancement in venous phase. Nine cases were performed venous phased enhanced scan. Two benign neoplasms appeared conspicuous enhancement. Seven malignant neoplasms appeared inhomogeneous enhancement. Conclusions MDCTE is simple and feasible,and is received easily by patients with small bowel GIST. MDCTE can provide valuable information based on morphology, density and pattern of enhancement. It is necessary to follow up after operation in atypical neoplasms.