胃肠道间质瘤的超声诊断价值分析

Analysis of ultrasound value in diagnosis of gastrointestinal stromal tumors

目的分析胃肠道间质瘤的超声图像特点,探讨超声检查对该肿瘤的诊断价值。方法选择24例经手术病理组织证实的胃肠道间质瘤患者,其中男性11例,女性13例;年龄25~76岁,平均年龄53.6岁。回顾性分析其超声图像,评价肿物的发生部位、大小、形态、边界、内部回声、血流信号、生长方式及有无转移等影像学特点。结果 24例胃肠道间质瘤中,15例发生于胃部,4例发生于小肠,3例发生于结肠,2例发生于直肠。瘤体直径〈5 cm 13例,瘤体直径〉5 cm 11例。形态规整13例,形态不规整11例;边界清楚14例,边界模糊10例;内呈均匀低回声11例,内呈不均匀低回声伴许多气体样回声6例,内呈不均匀低回声伴液性回声7例;瘤体血流信号不丰富14例,血流信号丰富10例;向消化道腔内生长7例,向消化道腔外生长17例;术前转移1例,术前未发生转移23例。胃肠道间质瘤典型超声图像特点：①瘤体直径〈5 cm肿瘤,多呈圆形或椭圆形,形态规整,边界清楚,内呈均匀低回声,瘤体血液运行一般不丰富,多向消化道管腔外生长;②瘤体直径〉5 cm时,形态不规整,边界不清,肿瘤内多表现为囊实混合回声,或许多气体样强回声团,彩色多普勒血流成像于瘤体实性部分可检出丰富血流信号,多向消化道管腔外生长。结论胃肠道间质瘤超声图像表现有一定的特征性,超声检查对胃肠道间质瘤的诊断有较大临床应用价值,可为临床治疗方案的选择提供重要的参考依据。

Objective To analyze the ultrasound imaging features of gastrointestinal stromal tumors （GIST）, and evaluate the ultrasound value in diagnosis of GIST. Methods A total of 24 patients with GIST confirmed by operation and pathology were enrolled, included 11 males and 13 females, which aged 25 - 76 years old with mean age of 53.6 years old. The ultrasound imaging of 24 cases were analyzed retrospectively. The imaging features included location, size, morphology, margin, internal echo, blood flow, growth pattern and metastasis were investigated and recorded. Results In 24 cases, 15 lesions were located in stomach, 4 in small intestine, 3 in colon and 2 in rectum. The tumor diameters of 13 cases were below 5 em and 11 cases above 5 cm. The 13 cases showed regular morphology and 11 eases with irregular morphology. The 14 cases showed clear margin and 10 cases with unclear margin. The 11 cases were even low echo and 6 cases were low heterogeneous echo with air-filled cavities, 7 cases were mixed cystic and solid echo. The blood flow of 14 cases was poor and 10 cases were abundant. There were 7 introphytic growth tumors and 17 exophytic growth tumors. The preoperative metastasis in 1 case and 23 cases were no metastasis. The ultrasound imaging features of GIST showed that ①the diameter of tumors were below 5 cm, stromal tumor were round or oval with regular shape and clear margin, the internal echo was even low echo, but without rich blood flow supply; ②the diameter of tumors were above 5 cm, stromal tumor was larger with irregular shape and unclear margin, internal echo was cystic solid mixed echo or gas-like strong echoes. In solid tumor, the color Doppler flow imaging was detected rich blood flow signals, which grew outside the digestive tract lumen. Conclusion It is demonstrated that ultrasound imaging findings of GIST have some characteristics, and show important clinical application value in the diagnosis of GIST, which provide an important basis for clinical treatment management.