胃肠道间质瘤的MSCT诊断及误、漏诊分析

Multi-slice Spire CT Diagnosis of Gastrointestinal Stromal Tumors and Analysis of Misdiagnosis and Missed Diagnosis

目的探讨胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的MSCT表现及误、漏诊原因,提高对该病的诊断准确性。资料与方法回顾性分析79例经病理证实的初诊的GIST患者的临床病理及MSCT表现。结果 79例中,CT定位正确66例(83.54%),其中定位食管2例,胃44例,小肠11例,结直肠7例,胃肠道外2例;CT确诊58例(73.4%),其中食管1例,胃41例,小肠9例,结直肠6例,胃肠道外1例;误诊主要疾病是平滑肌瘤、胃/肠癌、胃/肠淋巴瘤、纤维瘤等。10例(12.66%)伴发其他肿瘤,其中6例伴发其他肿瘤的间质瘤和1例间质瘤伴发神经纤维瘤病漏诊。结论对肿块与胃肠道关系的错误判断和对间质瘤伴发肿瘤的认识不足是误、漏诊的主要原因;多方位观察、充分充盈胃肠道的薄层增强CT扫描可准确评判肿块与肠管的关系及其供血血管的来源;充分认识间质瘤伴发其他肿瘤的特点,有助于提高CT对GIST的诊断准确性。

Objective To investigate multi-slice spire CT manifestions of gastrointestinal stromal tumors（GISTs）and analyze the misdiagnosis and missed diagnosis reasons,in order to improve the diagnosis accuracy.Materials and Methods Clinical data and CT images of 79 patients with GISTs,all confirmed by pathology and immunohistochemistry,were retrospectively analyzed.Results 66/79 locating diagnosis were correct and 58/79 cases CT diagnosis were correct.The main misdiagnoses were leiomyoma,cancer,lymphoma and fibroma.10 cases（12.66%）GISTs accompanied with others tumor,and 6 cases of GISTs and 1 case of neurofibromatosis were missed diagnosis before operation.Conclusion Erroneous judgments the relationship of the tumor and gastrointestinal tract and lack knowledge about accompany tumors of GISTs were the major factors responsible for misdiagnosis and missed diagnosis.Accurate judgments the tumors＇ blood supply vessel and their relationship with gastrointestinal tract are based on the suitable CT exam methods.Overall knowledge about GISTs may conduce to correct diagnosis.