胃肠道间质瘤的CT表现及免疫组化分型关系的研究

The Relationship between CT Manifestations and Immunohistochemical Typing of Gastrointestinal Stromal Tumors

目的:探讨多层螺旋CT在胃肠道间质瘤诊断中的应用价值,并观察其表现与免疫组化分析的关系,从而为临床对肿瘤分级制定诊疗方案提供参考。方法:选取2014年4月至2017年4月期间于本院收治的经手术病理证实的80例胃肠道间质瘤患者作为研究对象,其中胃部病变48例,小肠病变23例,腹腔内病变7例,食管病变1例,腹膜后病变1例。所有患者行CT扫描,统计肿块部位、大小、形态、边界、肿块生长方式、坏死程度、钙化情况,并与免疫组化分型进行对照分析。结果:80例患者中,平滑肌方向分化、神经方向分化、平滑肌和神经双向分化、缺乏分化特征分别有24例、19例、9例、28例。80例患者共有85个胃肠道间质瘤病灶,其中40个病灶的直径<5cm,31个病灶的直径是5~10cm;14个病灶的直径>10cm。52个病灶的轮廓比较规整,33个病灶为不规则形或者分叶状。72个病灶的边界清晰,13个病灶由于和周围粘连或者浸润生长其边界不清晰。55个病灶为外生型,20个病灶为跨壁生长型,10个病灶为内生型。40个病灶无明显坏死,有27个病灶存在局灶性坏死,有18个病灶存在广泛性坏死。平滑肌方向分化组的肿块直径>10cm、肿块显著强化、肿块广泛性坏死的比例明显高于神经方向分化组、平滑肌和神经双向分化组、缺乏分化特征组(P<0.05)。结论:CT检查是对胃肠道间质瘤进行临床诊断的一种有效方式,对胃肠道间质瘤的相关CT表现给予仔细的观察有利于判断肿瘤的免疫组化分型,存在十分重要的使用价值和意义,可进一步推广使用。

Objective： To study the CT applied value in the diagnosis of gastrointestinal stromal tumor,and observe its performance and the relationship with immunohistochemical,so as to provide reference for staging for clinical diagnosis and treatment plan. Methods： 80 cases of gastrointestinal stromal tumors confirmed by operation and pathology in our hospital from April 2014 to April 2017 were selected as the research objects,including 48 cases of gastric lesions,23 cases of small intestinal lesions,7 cases of abdominal lesions,1 case of esophageal lesions,1 case of retroperitoneal lesions. All patients underwent CT scan. The location,size,shape,border,growth pattern,necrosis degree and calcification of the tumor were statistically analyzed,and compared with immunohistochemical typing. Results： In 80 patients,there were 24 cases,19 cases,9 cases and 28 cases of smooth muscle differentiation,nerve orientation differentiation,smooth muscle and nerve bidirectional differentiation and lack of differentiation. Eighty patients had 85 gastrointestinal stromal tumors,of which 40 were diameter less than 5 cm,and 31 lesions were 5 ~ 10 cm in diameter. The diameter of 14 lesions was more than 10 cm. The contour of 52 lesions was fairly regular,and 33 lesions were irregular or lobule. The boundaries of 72 lesions were clear and 13 lesions were not clearly defined by the adhesion or infiltration of the surrounding area. 55 lesions were exogenous,20 lesions were cross-wall growth,and 10 lesions were endogenous. There was no obvious necrosis in 40 lesions,27 lesions were focal necrosis,and 18 lesions had extensive necrosis. Smooth muscle mass direction differentiation group 10 cm in diameter,mass increase,the mass proportion of extensive necrosis was obviously higher than that of neural differentiation of direction group,the smooth muscle and nerve two-way characteristics,lack of differentiation groups（ P〈0.05）. Conclusion： CT examination is a clinical diagnosis of gastrointestinal stromal tumor is an effective way,to the CT manifestation of gastrointestinal stromal tumor give careful observation to determine tumor immune group tumble type,it is of great use value and significance,can further promote the use.