多层螺旋CT在胃肠道间质瘤恶性风险评估中的价值

Prediction of malignancy degree of gastrointestinal stromal tumor with multi-slice CT

目的探讨多层螺旋CT(MSCT)在胃肠道间质瘤(GIST)恶性风险评估中的价值。方法回顾性分析48例经病理和免疫组化证实的胃肠道间质瘤的CT影像特征与恶性风险分级之间的联系。结果 MSCT定位准确率100%。48例胃肠道间质瘤中包括胃间质瘤30例,小肠间质瘤18例。低危组胃间质瘤22例,病灶直径在5 cm以下,病灶形态以圆形、椭圆形为主(20/22),边界清楚,密度均匀,增强扫描后肿瘤CT强化幅值多小于25 Hu(15/22);高危组胃肠道间质瘤26例,包括胃间质瘤8例、小肠间质瘤18例,病灶直径多在5 cm以上,病灶形态以分叶状多见(20/26),坏死、钙化多见,分别为23/26、14/26,增强扫描后肿瘤CT增强幅值多在25 Hu以上(18/26)。3例肿瘤发现肝转移。结论 MSCT可以对胃肠道间质瘤进行准确定位,其CT表现特征与恶性风险程度之间存在一定的相关性,MSCT可以为胃肠道间质瘤的术前恶性风险评估提供有价值参考。

Objective To evaluate the value of multislice CT（MSCT） in prediction of malignancy degree of gastrointestinal stromal tumors（GIST）.Methods The relation between CT features and malignancy degree of 48 cases of GIST confirmed by pathology and immunohistochemistry were analyzed retrospectively.Results The origination of all the 48 cases of GIST were accurately showed on MSCT,of which 30 originated from stomach and 18 from bowel.Of all the lesions,22 cases of stomach GISTs were diagnosed as low degree malignancy,8 stomach GISTs and 18 small bowel GISTs were diagnosed as high degree malignancy.The 22 cases of low degree malignancy were all less than 5 cm in diameter,usually round or oval in shape（20/22）,with clear configuration and homogenous density and had enhancement of less than 25 Hu after contrast administration（15/22）.26 high degree malignant cases were usually more than 5 cm in diameter,with irregular shape（20/26）,necrosis,and calcification were often found within the tumors（23/26,14/26）.The enhancement of tumor were almost more than 25 Hu after contrast administration（18/26）.Liver metastases were showed in 3 cases.Conclusion MSCT can accurately showed the origination of GIST.There was certain relation between CT characteristics and malignancy degree of GIST.MSCT can provide helpful information for the prediction of malignancy degree of GIST before operation.