胃肠道间质瘤的消化道钡餐和MSCT诊断

BARIUM MEAL EXAMINATION AND MULTI-SLICE CT IN THE DIAGNOSIS OF GASTROINTESTINAL STROMAL TUMORS

目的分析胃肠道间质瘤的消化道钡餐及多层螺旋CT(MSCT)表现,探讨消化道钡餐和MSCT在胃肠道间质瘤诊断中的价值。方法回顾性分析29例经手术病理证实为胃肠道间质瘤病人术前消化道钡餐和MSCT影像学资料,根据影像征象分析病变性质并与病理结果进行对照。结果病理检查显示,29例胃肠道间质瘤中,胃间质瘤17例,肠道间质瘤11例,胃及十二指肠同时发病者1例。消化道钡餐诊断胃间质瘤9例,肠道间质瘤5例;良性11例,包块多呈圆形或椭圆形,腔内生长为主;恶性3例,包块形态不规则,边界清或不清。MSCT诊断胃间质瘤15例,肠道间质瘤10例;良性16例,包块多呈圆形或椭圆形,腔内外生长均有,密度均匀,边界清晰;恶性9例,多为腔外生长的不规则包块,体积较大(>5cm),增强后多呈不均匀强化,病变中心可出现大片低密度影,其中2例出现肝转移。结论胃肠道间质瘤消化道钡餐及MSCT表现具有一定特征性,MSCT能准确诊断胃肠道间质瘤与周围组织关系,对设计治疗方案及评估预后有重要价值。

Objective To analyze the manifestations of gastrointestinal stromal tumor （GIST） on barium meal examina tion and MSCT, and investigate the value of the two methods in the diagnosis of this condition. Methods Using double blind method, the information of preoperative barium meal and MSCT of 29 patients with GIST confirmed by surgery and pathology were analyzed retrospectively. A comparison was done between the signs of imageology and pathology. Results Pathologically, of the 29 cases, stromal tumor （ST） of stomach was found in 17 cases, intestine 11, simultaneous stomach and duodenum in one. Barium meal examination showed ST in stomach in nine, intestine in five; benign in 11, the masses mostly appeared as round or oval shape, and growth intracavity; malignant was reported in three, with irregular shape, the boundary was clear or not. MSCT reported 15 were ST of stomach, 10 were of intestine： 16 were benign, most of the masses were round or oval in shape, which grew within the cavity or outside, with well distributed density and sharpness of border; malignant ST was noted in nine, more grew outside the cavity with irregular masses, the size being bigger （〉5 cm）, uneven enrichment was seen after enhancement, a sheet of low density shadow could be seen, in which, two with liver metastasis. Conclusion There is a certain mark of GIST on barium meal examination and MSCT, but, the latter can accurately define the relationship between GIST and its surrounding tissues, which shows significance in making therapeutic proposal and assessing the prognosis of the disease.