多层螺旋CT对胃肠道间质瘤的诊断及评估价值

The diagnosis and estimated value of multi-slice spiral CT to gastrointestinal stromal tumor

目的:探讨多层螺旋CT对胃肠道间质瘤的特异性征象及诊断价值。方法:对手术病理及免疫组化证实的29例胃肠道间质瘤患者的临床资料进行回顾性分析,所有患者均行128层螺旋CT平扫及多期动态增强扫描。结果:29例病例中,病灶发生于食管2例,胃12例,十二指肠4例,空肠回3例,结肠2例,直肠1例,肠系膜及大网膜内5例;其中腔内型9例,腔外型11例,肌壁间型4例,胃肠道外型5例;良性13例,肿瘤直径均≤4.5 cm,边界多清楚,圆形或类圆形,密度较均匀,不侵犯邻近组织,多呈实体型均匀强化;潜在恶性6例,肿瘤特性与良性肿瘤大致相同;恶性10例,肿瘤直径均>5.0 cm,肿瘤边缘呈分叶状或不规则形,瘤体内可见不同程度囊变坏死,部分病例瘤体内见细小钙化,增强扫描强化不均一,瘤体旁常可见簇状或线状排列的小血管,与邻近组织粘连、侵犯或远处转移。结论:胃肠道间质瘤的多层螺旋CT表现有一定的特异性,能够较准确显示病灶的部位、形态和大小,并对肿瘤的良恶性鉴别提供依据,有助于准确诊断胃肠道间质瘤,指导临床治疗及预后评估。

Objective ： To investigate distinctive sign and estimated value of multi-slice spiral CT to gastrointestinal stromal tumor. Methods ：To proved by pathological and immunohistochemical the clinical data of 29 patients with gastrointestinal stro- mal tumors were retrospectively analyzed, all the patients were performed 128 layer spiral CT scan, and muhiphase dynamic en- hanced scan. Results ：This group of 29 cases,lesions occurred in 2 cases of the esophagus, 12 cases lesions occur in the stom- ach,4 cases were lesions occurred in the duodenum. 3 cases were lesions occurred in the back to the jejunum,2 cases were le- sions occurred in the colon, 1 cases were lesions occurred in the rectum,5 cases were lesions occurred in the Mesenteric and o-mental. The cavity type 9 cases, Cavity shape in 11 cases. Between muscle wall type 4 cases, gastrointestinal tract in 5 cases ; 13 cases of benign, Tumor diameter is 4.5 cm or less, boundary more clear and round or class round, density is uniform, not nearby tissue invasion, formed a homogeneous enhancement has entity type;Malignant potential 6 cases, Tumor characteristics and be- nign tumor are roughly the same;10 cases of malignant. Tumors were greater than 5.0 cm in diameter, the tumor in marginal or irregular, Lobulated tumors had different levels can be seen in the cysts become necrotic, Some cases of tumors in see tiny cal- cification,enhancement scan intensive inhomogeneity. Next to the tumors often visible clumps or linear arrangement of small blood vessels, and adjacent tissue adhesion, invasion or distant metastasis. Conclusion： Gastrointestinal stromal tumor of the multi-slice spiral CT performance has certain specificity, can accurately show lesion area, shape and size, and provide a basis for identification of benign and malignant tumor, help to accurate diagnosis of gastrointestinal stromal tumor, guide clinical treatment and prognosis assessment.