胃肠道间质瘤的螺旋CT诊断

Helical CT diagnosis of gastrointestinal stromal tumors(GIST)

目的探讨胃肠道间质瘤(GIST)的螺旋CT诊断价值。方法回顾性分析经手术病理证实的16例胃肠道间质瘤的螺旋CT表现。结果良性10例,恶性5例,交界性1例。位于胃部10例,十二指肠2例,空肠2例,回肠2例;肿瘤位于腔内5例,腔外11例,均为单发肿瘤。CT表现:良性GIST(含交界性1例)肿瘤最大径均小于4cm;恶性GIST肿瘤最大径均大于5cm。(1)平扫:良性GIST呈圆形或类圆形,边缘光整,密度较均匀;恶性GIST呈分叶状,部分边缘不清,瘤内密度不均,呈囊实性改变;1列回肠恶性GIST显示肿瘤细蒂与肠管壁相连,2例见点状及小斑片钙化。(2)增强:良性GIST多呈均匀性强化;恶性GIST呈不均匀性强化,实性部分强化,瘤内见不规则无强化坏死区,瘤内可见不规则扭曲异常强化血管影。结论胃肠道间质瘤的CT表现具有一定的特征性,CT检查有助于肿瘤的定位及肿瘤良恶性的判断。

Objective To investigate the diagnostic value of MSCT imaging in diagnosis of gastrointestinal stromal tumor （GIST）. Methods Helical CT findings of 16 cases with GIST proved by pathology were retrospectively analyzed. Results The 16 GISTs included 10 benign tumors, 5 malignant tumors,and one borderline tumor. The tumors were of gastric （n = 10）, duodenum （n = 2）, jejunum （n = 2）, ileum （ n = 2） origin. There were 11 exophytic growth tumors and 5 intracavitary growth tumors of 16 gastrointestinal tract solitary origin tumors. On CT examinations, 10 benign tumors （including one borderline tumor） appeared as round or oval, clear rim and homogeneous density, the maximum diameter〈4cm. After iv administration of contrast materials, the benign tumors demonstrated homogeneous enhancement, while the 5 malignant tumors showed the maximum diameter□6cm, lobulated, indistinct rim, cystic and solid mixed and heterogeneous enhancement. Remarkable enhancement was seen in the parenchyma of the tumor, while no enhancement was revealed in the necrosis and cystic area of the tumor, and squirm vessels were showed inside tumor. One malignant lesion was connected to intestinal wall with a small stem. Some calcification was found in 2 cases. Conclusion Helical CT imaging manifestations of GIST have some characteristics and could be made for locating, qualitative and staging diagnosis in GIST.