胃肠道间质瘤的误诊因素分析及鉴别

Misdiagnosis factors and differential diagnosis of gastrointestinal stromal tumors

目的:分析胃肠道间质瘤(GIST)的影像误诊因素及鉴别要点。方法:搜集术前误诊为GIST患者11例,GIST患者术前未正确诊断2例作为此次研究的对象,对所有患者的影像资料进行回顾分析。13例患者均有手术病理,进行MSCT扫描,观察CT影像特征,分析误诊或未正确诊断GIST的影像学因素及鉴别价值。结果:13例误诊患者中,2例为腹膜后神经鞘瘤、2例为低分化腺癌、2例为异位胰腺、1例为类癌、1例为平滑肌瘤、1例为未分化肉瘤、2例为转移性癌、另外2例小肠间质瘤术前未正确诊断。误诊与肿瘤发生部位、大小、血供来源、生长趋势、观察方法等因素有关。结论:GIST有一定的影像特点,降低胃肠道间质瘤的误诊,三维重建-肿块准确定位是重中之重,其次应仔细观察肿块细微关键征象,注意肿块血供来源及生长趋势也是鉴别要点。

Objective To analyze factors causing misdiagnosis of gastrointestinal stromal tumors （GIST） and provide some key points for the differential diagnosis of GIST. Methods The imaging data of 11 patients who were misdiagnosed as GIST and 2 patients with GIST who were misdiagnosed before operation in Guangzhou Red Cross Hospital from April 2014 to May 2017 were retrospectively analyzed. All 13 cases were confirmed by operation and pathology and underwent MSCT scanning. We observed the features of CT imaging, analyzed the imaging factors affecting the diagnosis of GIST and evaluated their values in differential diagnosis. Results The pathological diagnosis results of 13 patients who were all misdiagnosed included retroperitoneal schwannoma （2/13）, poorly differentiated adenocarcinoma （2/13）, ectopic pancreas （2/13）, gastrointestinal carcinoid （1/13）, leiomyoma （1/13）, undifferentiated sarcoma （1/13）, metastatic carcinoma （2/13） and small intestinal stromal tumor （2/13）. Misdiagnosis was related to tumor location, size, source of blood supply, growth trend, observation method and so on. Conclusion GIST has some certain imaging features. To reduce misdiagnosis rate, accurate localization of mass in three-dimensional reconstruction is the priority among priorities; the observation of subtle but key signs about mass are also important; and the source of blood supply and growth trend of mass should also be considered in the differential diagnosis of GIST.