CTA对小肠间质瘤的诊断价值

Diagnostic value of spiral CT and multi-slice spiral CT angiography in intestinal stromal tumor

目的评价螺旋CT与螺旋CT血管造影（MSCTA）对小肠间质瘤的诊断价值。方法回顾性分析19例经手术病理证实小肠间质瘤的螺旋CT扫描与MSCTA结果。结果19例中良性12例，恶性7例；肿瘤大小约2～15cm。19例中CT及MSCTA发现病灶有16例，即定性诊断准确率为84．21％。根据手术中探查结果，CT及MSCTA定位诊断的准确率为73．68％。小肠间质瘤螺旋CT及MSCTA影像表现有：肿瘤呈软组织块影，平扫密度均匀9例，其中2例见坏死灶，1例见钙化。密度不均匀7例，肿块呈分叶状，同时伴有肠腔狭窄。2例小肠梗阻病人有肠套叠表现。增强扫描显示9例呈不均匀的明显强化，7例呈均匀的明显强化，在动脉期较明显，可以看到病灶中心坏死，周围呈花边样强化。CT显示1例肝转移，1例腹膜多发转移。16例MSCTA见：15例肿瘤由肠系膜上动脉供血，1例由腹腔动脉供血，肿瘤供血血管明显增粗，并且可以看到明显增粗的回流静脉。结论螺旋CT与MSCTA无创伤性，在小肠间质瘤定性、定位诊断及指导治疗方面有着重要的临床意义。

Objective To evaluate the imaging diagnostic value of spiral CT and multi-slice spiral CT angiography（MSCTA） in intestinal stromal tumor. Methods Nineteen cases of intestinal stromal tumor confirmed surgically and pathologically with integrated CT and pathologic data were analyzed retrospectively. Results Twelve cases were benign and 7 cases were malignant. The maximum diameter of these tumors ranged from 2 cm to 15 cm. Accuracy rate of CT diagnosis for localizing and differentiating the benign or malignant intestinal stromal tumor was 73. 68 % and 84. 21 % respectively. The tumors appeared as homogeneous dense solid（9 cases）, two cases had necrosis region and 1 case had calcification. The tumors appeared as heterogeneous dense solid （7 cases）, and the shape was lobulated with intestinal tract stricture. Nine cases appeared conspicuous enhancement and 7 cases appeared in homogeneous enhancement. Necrosis changes in the center and lace pattern enhancement were found especially in arterial phase. The dilated tumor feeding vessel could be found on MSCTA. Feeding vessel was superior mesenteric artery in 15 cases, and celiac artery in one case. Conclusion MSCTA is simple and feasible. Spiral CT examination can demonstrate important features of intestinal stromal tumor, and MSCTA provides important information for the localization and the diagnosis of the small-bowel stromal tumor.