CT与胃肠道造影诊断小肠原发恶性肿瘤的比较研究

Comparative study between CT and gastrointestinal tract radiography in the diagnosis of primary malignant small intestinal tumors

目的评价CT和常规胃肠道造影对小肠原发恶性肿瘤诊断的准确性。方法收集52例经手术和病理证实小肠原发恶性肿瘤的胃肠道造影、CT、血管造影及临床资料,回顾性分析其胃肠道造影和CT影像特征,并与手术和病理学结果进行对照。结果 52例小肠原发恶性肿瘤中腺癌19例,恶性间质瘤10例,恶性淋巴瘤23例。常规胃肠道造影主要表现为肠管狭窄、充盈缺损、管壁僵硬、黏膜破坏及环状皱襞消失、肠梗阻、肠套叠及溃疡形成等,41例得到了准确定位,肯定肿瘤诊断32例。CT检查20例,主要表现为局部肠壁增厚、小肠肿块、肠管狭窄、肠梗阻、肠套叠等,均得到了准确定位,肯定肿瘤诊断18例。肠系膜上动脉造影3例,均明确了出血的部位,但术前均误诊为血管畸形。结论 CT对小肠原发恶性肿瘤的诊断具有更高的准确性,并能提供有关肿瘤局部浸润、淋巴结远处转移以及并发症等影像学信息,常规胃肠道造影与CT检查相结合有助于制订出更为恰当的治疗计划。

Objective To evaluate the accuracy of CT and conventional gastrointestinal （GI） tract radiography in the diagnosis of primary malignant tumors of the small intestine.Methods Fifty-two patients with primary malignant small intestinal tumors confirmed by operation and pathology were selected for this study.Their images of CT,conventional GI tract radiography,angiography and clinical data were analyzed retrospectively.The imaging findings were compared with surgical and histopathologic results.Results The lesions included adenocarcinomas （19 cases）,malignant stromal tumors （10 cases） and lymphomas （23 cases）.The main imaging manifestations of GI tract radiography were intestinal stenosis,filling defect,stiffness of involved intestinal wall with mucosal destruction and loss of valvulae conniventes,intestinal obstruction,intussuseption,ulcer,and so on.Accurate localizing and qualitative diagnosis were obtained in 41 and 32 cases respectively.20 patients were examined by a spiral CT or MSCT scanner,the main CT findings were bowel wall thickening,mass,stenosis,obstruction,intussuseption,etc.In all 20 patients,accurate localizing diagnosis was achieved and qualitative diagnosis was obtained in 18 cases.Superior mesenteric arterial angiography was performed in 3 patients,and the hemorrhagic location was identified.But,all 3 cases were preoperatively misdiagnosed as vascular malformation.Conclusions CT is more accurate than conventional GI tract radiography for diagnosing primary malignant small intestinal tumors,and can provide extra imaging information about the local invasion,metastasis,complications,and so on.Conventional GI tract radiography combined with CT is useful for the selection of the operative project and the therapy plan.