胃肠道内外间质瘤影像表现与病理危险级别相关分析

Comparative study of image features and degrees of malignancy of gastrointestinal stromal tumors and extragastrointestinal stromal tumors

目的:探讨胃肠道内外间质瘤CT、MR表现及临床病理特点,及两者相关性。方法:回顾性分析我院27例经手术病理证实的胃肠道内、外间质瘤影像表现及其临床病理资料,对照分析影像表现与免疫组化、病理危险级别相关性。结果:27例病例均为单发病灶。病变位于胃11例,小肠5例,直肠2例,十二指肠1例,胃肠道外肠系膜及腹膜后8例。10例病灶呈圆形,其中6例位于胃,4例呈椭圆形,13例呈分叶形。直径>5.0cm 17例,直径<5.0cm 10例。其中19例病灶密度不均,18例病灶内见局部液化坏死,3例出现溃疡、3例出现瘘道,8例病灶密度均匀。增强扫描动脉期23例病灶边缘索条状或血管样强化,实质期全部病灶实性成分均表现进一步强化。其中4例出现肝脏转移,4例出现周围侵犯,均未出现区域淋巴结转移。病理结果:CD117(+)、CD34(+)23例,CD117(+)、CD34(-)3例,CD117(-)、CD34(+)1例;病理危险级别分组:极低危险组1例、低危险组5例、中危险组3例、高危险组18例。结论:胃肠道间质瘤影像表现具有一定特征性,病灶直径大于5.0cm,形态不规则,密度不均和/或伴液化坏死、瘘道形成,增强出现索条或血管样强化,出现周围侵犯及转移等影像表现常提示病理危险级别为中、高危险组,即恶性表现,预后不良。

Objective：To study image features and degrees of malignancy of gastrointestinal stromal tumors and extragastrointestinal stromal tumors.Methods：Retrospectively studied image features of 27 cases with gastrointestinal stromal tumor GIST or extragastrointestinal stromal tumor EGTST confirmed by operation and pathology.Results：The lesions were single in 27 cases.Tumors originated from stomach （n =11）,small intestine （n =5）,rectum （n =2）,duodenum （n =1） and abdominal mesentery or periteneum （n =8）.Contours of the tumor were round （n =10）,ellipse （n =4）,irregular or lobulated （n =13）.The diameter of masses was less than 5.0cm（n =10）,greater than 5.0cm （n =17）.The tumor showed uneven density （n =19）,even density （n =8）,and showed necrosis （n =18）,ulcer （n =3）,fistula（n =3）.On enhanced CT or MRI,these tumors showed obvious heterogeneous enhancement and like artety shadow atarterial phase（n =23）.4 cases appeared liver metastasis,4 cases appeared around violate.All cases were including 1 less low-risk,5 low-risk,3 intermediated-risk,18 high-risk lesions.Conclusion：Gastrointestinal stromal tumor is of certain image characteristics,GISTs or EGISTs with larger size,irregular or lobulated,uneven density and necrosis,fistula.On enhanced CT or MRI showed obvious heterogeneous enhancement and like artety shadow atarterial phase are prompting high-risk lesions.