胃间质瘤与非胃间质瘤的CT征象及病理学分级的对比研究

Comparative Analysis of CT Findings and Pathological Grading in Gastric Stromal Tumour and Extragastric Stromal Tumour

目的对比分析胃间质瘤与非胃间质瘤的CT征象及病理分级之间的差异,探讨胃肠间质瘤(GIST)的恶性风险与发生部位之间的相关性。方法选择经手术病理证实且CT资料完整的64例GIST患者资料,按照病灶发生部位将其分为胃间质瘤组与非胃间质瘤组。采用秩和检验对比分析两组之间CT影像学征象及病理学差异。其中对间质瘤的生长方式比较采用Kruskal-Wallis检验,余均采用Mann-Whitney检验。结果当肿瘤直径≤5 cm,非胃间质瘤恶性风险明显高于胃间质瘤(P<0.05);且CT征象分别为圆形、腔内生长方式、无坏死、轻中度强化时,非胃间质瘤组与胃间质瘤组恶性风险差异均有统计学意义(P<0.05)。组内对比:胃间质瘤肿块>5 cm、有坏死、重度强化者及发生转移的肿瘤恶性风险更高;非胃间质瘤组内3种生长方式对应的风险程度差异均有统计学意义(P<0.05),其中腔内生长方式的恶性风险显著性高于腔外生长方式(P=0.042),且肿瘤有坏死比没有坏死恶性程度更高(P=0.001)。结论非胃来源间质瘤恶性风险高于胃间质瘤,且腔内生长方式的非胃来源间质瘤恶性程度更高,CT影像学征象有助于指导临床制定治疗方案。

Objective To analyze the difference of CT findings and pathological grading between gastric stromal tumour and extragastric stromal tumour, and to investigate the correlation between malignancy risk and location of gastrointestinal stromal tumours（GIST）. Methods Sixty four patients with GIST proved by pathology and CT data were included in the study. All the cases were divided into gastric stromal tumour group and extragastric stromal tumour group by WHO classifi- cation standard. The pathological grade and CT findings of two groups were comparative analyzed using rank sum test. The growing modes of stromal tumour was tested by Kruskal Wallis test, and others using Mann Whitney test. Results The ma- lignancy risk of extragastric stromal tumor was significantly higher than gastric stromal tumor when tumor size was ~〈 5 cm in diameter. The malignancy risk had significant difference between two groups when the tumors showed round shape, grow- ing in cavity, no necrosis and moderate enhancement on CT images. For gastric stromal tumors, the tumors had more malig- nancy risk when the tumors were bigger than 5cm, showed necrosis, obvious enhancement and metastasis. For extragastric stromal tumor group, there was statistical difference between three growing modes（ P 〈 0.05 ）. And the pathological grading of growing in cavities was significantly higher than that growing outside cavities （ P = 0. 042）. The malignancy degree of tumors with necrosis were higher than those without necrosis （P = 0. 001 ）. Conclusion The malignancy risk of extragas- tric stromal tumor is significantly higher than that of gastric stromal tumor, especially the tumors growing in cavities. The CT imaging can help to clinical treatment.