多排螺旋CT小肠造影在小肠间质瘤中的临床应用价值

Clinical applications value of small - bowel stromal tumors in multidetector - row CT angiography

目的分析小肠间质瘤的CT影像学表现，探讨多排螺旋CT（MDCT）小肠造影在小肠间质瘤中的应用价值。方法对21例经病理证实的小肠间质瘤患者行MDCT平扫及增强扫描，并在ADW4．4工作站进行后处理，分析小肠间质瘤CT征象与恶性度。结果21例小肠间质瘤发生部位：十二指肠1例，空肠13例，回肠7例；良恶性：良性间质瘤4例，恶性间质瘤14例，交界性3例。CT表现特征为肠壁偏心性软组织肿块。良性倾向者多表现为圆形或类圆形，最大径多〈4cm，边界清，密度均匀，增强多显著均匀强化。恶性倾向（交界性和恶性）者多表现为分叶状或不规则肿块，最大径多〉4cm，其内多见低密度坏死囊变区，增强扫描动静脉期肿瘤实质部分明显强化，内部坏死囊变区未见强化。结论MDCT及重建技术能够显示病变的特征及其与周围的关系，对小肠间质瘤的定位、定性及指导治疗有重要价值，可作为小肠间质瘤的重要检查方法。

Objective To analyze CT features of small - bowel stromal tumors and to investigate the value of multi - detector CT （MDCT） in diagnosis of small - bowel stromal tumors. Methods Twen- ty- one patients with pathologically proven small bowel stromal tumors were examined by enhanced MDCT scan. The images were processed by Advantage workstation 4.4 （ADW4.4） and intestinal stromal tumor CT signs and malignant degrees were analyzed. Results Among the 21 cases, there were 13 cases which tumors originated from the jejunum, and 7 cases from ileum, only 1 case from duodenum. Among the 21cases,4 cases were benign, 14 cases were malignant and 3 cases were borderline tumors. CT images showed soft tissue mass in the eccentric wall. More benign tendencies showed round or oval, more than the maximum diameter of less than 4 cm. The density was even, the boundary was clear enhanced scan showed significantly more homogeneous enhancement. Malignant tendency （borderline and malignant ） were more performance for the lobulated or irregular masses. Maximum diameter greater than 4 cm. A- mong them sees the low density necrosis and the pouch variation area. In contrast enhanced scan, remark- able enhancement was seen in the parenehyma of the tumor, while no enhancement was revealed in the necrosis and cystic area of the tumor. Conclusions MDCT can show the characteristic of small bowel stromal tumors and the adjacent structure of the lesion, it plays a major role in the localization and in di- agnosis of small bowel stromal tumors, it is also helpful to instruct the clinical treatment, and as important detection method of intestinal stromal tumor.