胃肠间质瘤的64排螺旋CT征象分析

Analysis of 64 Layer Spiral CT Findings in Gastrointestinal Stromal Tumor

目的:胃肠间质瘤是消化系统最常见的间叶源性肿瘤,影像学检查在其术前诊断中起着重要作用。本研究旨在分析胃肠间质瘤的螺旋CT表现特点,以提高本病影像学诊断水平。材料与方法:回顾分析经手术病理及免疫组织化学证实的46例的胃肠间质瘤的临床及CT检查资料,分析肿瘤大小、形态、轮廓、生长方式、强化程度及坏死情况。并将CT表现与病理诊断进行对照。结果:胃部间质瘤27例、小肠14例、直肠3例、腹腔肠系膜2例,4例见远处转移。肿瘤以外生性生长为主,最大径≥50 mm者,CT表现为形态不规则,呈浸润性生长,可见囊变坏死,明显不均匀强化,多为高度危险性;最大径<50mm者,形态多规则,密度均匀,呈膨胀性生长,中度均匀强化,多为中度及以下危险性。CT多期扫描呈逐渐强化特点,门静脉期和延迟期强化明显,肿块周边及内部可见条状强化的血管影。未见淋巴结转移。结论:胃肠间质瘤的CT表现具有一定的特征性,CT检查对胃肠间质瘤的定位、定性诊断有重要价值。

Purpose ： Gastrointestinal stromal tumor （GIST） is one of the most common mesenchymal tumors of the digestive system. Imaging examination plays an important role in preoperative diagnosis for it. This study was to describe the multi - slice spiral computed tomographic findings of GIST, for improve the level of GIST diagnosis. Materials and Meth- ods： The abdominal CT characteristics and pathological manifestations of 45 surgically treated patients with histologically and immunohist ochemically confirmed GISTs were retrospect ively analyzed. Images were assessed for the size, morphous, con- tour, growth pattern, degree of enhancement, and necrosis of the tumors. The CT features of GIST were compared with the pathologic findings. Results： The tumors were found to originate from stomach （n =27）, small bowel （n = 14）, rectum（n = 3）, mesentery and omentum （ n = 2）, and with metastases （ n = 4）. Most of GISTs were well - detined and exophytic, the GIsT lesions with maximal diameter of≥50 mm showed irregular shape, invasive growth, presence of cystic area and het- erogeneous enhancement, and most of them were at high risk ： the Iesions with maximaI diameter of 〈 50 mm showed regular shape, expansive growth, and homogeneous enhancement, and most of them were at risk of moderate or below. The solid por- tion of tumors showed marked enhancement in the arterial and portal venous phase and jn the equilibrium phase. Enhanced striped vessels were seen in the tumors. No lymph node metastasis was found. Conclusion： GISTs have some specific CT findings which could be helpful for GIST location and qualitative diagnosis.