64层螺旋CT对胃间质瘤的诊断价值

Value of 64-Slice Spiral CT in Diagnosis of Gastric Stromal Tumor

目的探讨64层螺旋CT对胃间质瘤(GST)的诊断价值。方法收集2010年5月至2011年8月期间四川大学华西医院32例经手术病理证实的GST,按Fletcher恶性风险分级表进行恶性风险分级,回顾性分析其CT表现,通过病灶部位、大小、边界、形态、密度、生长方式、有无转移、增强后强化特点等分析CT征象与GST恶性风险间的关系。结果本组32例GST均为单发病灶,CT定位准确率为100%。腔内型9例,腔外型10例,腔内外型13例。低危组9例,直径均<5 cm,形态呈圆形或椭圆形,边界清楚,密度均匀,强化大多均匀(7/9);高危组23例,直径≥5 cm者19例,多呈不规则状、分叶状、边界不清楚(18/23),密度多不均匀(20/23),见囊变、坏死,6例可见溃疡,增强后实性部分呈渐进强化。高危组GST中3例邻近胰腺、脾脏受侵,2例伴左侧膈肌受累,1例伴大网膜转移,2例伴肝转移,1例病变旁淋巴结转移。结论多层螺旋CT是目前检查GST的最佳手段,其CT表现特征与恶性风险程度之间存在一定关系,可以为GST的术前恶性风险分析提供一定参考价值。

Objective To discuss the value of 64-slice spiral CT （MSCT） in diagnosis of gastric stromal tumor （GST）. Methods Thirty-two patients proved GST by surgery and pathology from May 2010 to August 2011 in West China Hospital, Sichuan University were classified by Fletcher malignancy degree classification, the CT features including the location, size, boundary, shape, density, growth pattern, metastases, and enhancement and its relationships to GST malignancy degree were analyzed retrospectively. Results All 32 cases were single lesion, the accuracy of CT in localization was 100%. Nine cases were intra-luminal, 10 were extra-luminal, and 13 were both intra- and extra-luminal growth. Nine cases were in low degree group, with diameter 〈 5 cm, round or oval in shape, clear border, homogenous density and enhancement （7/9） ; Twenty-three cases were in high degree group, with diameter ≥ 5 cm in 19 cases, irregular in shape and indistinct bourdry （18/23）, heterogeneous density （20/23） with necrosis, ulcer was seen in 6 cases. Three cases in high malignance degree group showed pancreas and spleen involvements, 2 cases of left diaphragm involvement, 1 of omentum metastasis, 2 of liver metastases, and 1 of lymph node metastasis. Conclusions MSCT is the optimal method to exam GST, there is correlation between the CT features and malignancy degree, MSCT is helpful for analyzing malignancy degree preoperation.