胃原发性神经内分泌瘤和间质瘤MSCT表现及对照研究

Imaging findings and a comparative study of the primary gastric neuroendocrine tumors and gastric stromal tumors on multi-slice CT

目的:探讨CT在胃原发性神经内分泌瘤和间质瘤鉴别中的应用价值,提高在临床工作中诊断的准确率。方法:回顾性分析经手术病理证实15例胃神经内分泌瘤和53例胃间质瘤的临床资料、上腹部CT平扫及双期增强扫描的影像资料;观察病灶的部位、形态、长径、生长方式、强化方式、溃疡、坏死囊变、钙化和淋巴结、转移、复发;统计学分析采用独立样本t检验(正态分布且方差齐)、卡方检验以及Fisher精确概率法。结果:性别、长径、年龄、钙化及周围淋巴结无统计学意义(P>0.05);囊变坏死、溃疡、位置、形态、生长方式、动脉期CT值、静脉期CT值及动脉期较平扫CT值有统计学意义(P<0.05),肿瘤囊变坏死(27/53)、溃疡(13/53),分叶状(17/53)及腔内外生长(28/53)有利于GIST的诊断,而NET好发于胃体(13/15);ROC曲线分析显示动脉期CT值、静脉期CT值、动脉期增强幅度有利于鉴别病灶为胃神经内分泌瘤,其曲线下面积、临界点、敏感度、特异度分别为:0.91、55.0HU、100%、72%,0.81、74.5HU、80%、87%,0.93、21.5HU、100%、74%。结论:不规则增厚及早期明显强化有利于诊断胃神经内分泌瘤;类圆形或分叶状、囊变坏死及增强后肿瘤实质部分中度到明显强化,有利于胃间质瘤的诊断。

Objective:To explore the application value of CT in differentiating the primary gastric neuroendocrine tumor from gastric stromal tumors,and improve the accuracy of diagnosis in clinical.Methods:The clinical data,preoperative abdominal plain CT and dual-phased contrast-enhanced CT of 15 cases of gastric neuroendocrine tumor and 53 cases of gastric stromal tumors confirmed by operation and pathology were analyzed retrospectively.The location,contour,size,growth pattern,degree and pattern of enhancement,surface ulceration,necrosis,calcification and lymph node,metastasis,recurrence were observed.Independent t-test(normal distribution and homogeneity of variance),chi-square test and Fisher accurate probability method were used in the statistical analysis.Results:There was no significant difference in sex,size,age,calcification and peripheral lymph nodes(P>0.05).The necrosis,surface ulceration,location,contour,growth pattern,arterial CT value,venous CT value,degree of enhancement in arterial phase were statistically significant(P<0.05).Tumor cyst necrosis(27/53),ulcer(13/53),lobulated(17/53)and intra-and extra-cavitary growth(28/53)were beneficial to the diagnosis of GIST,while NET was more common in the gastric body(13/15).ROC curve analysis showed that the area,critical point,sensitivity and specificity of the arterial phase CT value,the portal venous phase CT value,degree of enhancement in arterial phase more than plain CT value were 0.91,55.0HU,100%,72%;0.81,74.5HU,80%,87%;0.93,21.5HU,100%,74%,respectively.Conclusions:Irregular thickening and early-phase marked enhancement are helpful in the diagnosis of gastric neuroendocrine tumors.Circular or lobulated,necrosis and moderate to marked enhancement of the parenchyma of tumors are helpful in the diagnosis of gastric stromal tumors.