胃肠道间质瘤的多层螺旋CT多期增强与病理危险程度的相关性

Correlation between multistage enhancement of MSCT and pathologic risk of gastrointestinal stromal tumors

目的分析胃肠道间质瘤(GIST)的多层螺旋CT(MSCT)多期影像增强表现,探讨其评估GIST危险性的价值。方法回顾性分析经手术病理证实的47例GIST患者病例资料,所有病例均进行多期动态增强扫描,并将影像增强表现与术后的病理相对照。结果2例极低度危险性及18例低度危险性肿瘤直径均小于5 cm,形状规则,其中19例密度均匀,1例内部轻度囊变、坏死,增强后均匀强化17例,不均匀强化3例;12例中度危险性、15例高度危险性肿瘤直径>5 cm,形态多不规则,其中21例密度不均、病灶内囊变坏死,增强后均匀强化4例,不均匀强化23例;肿瘤大小与强化方式有统计学意义,>5 cm的肿瘤明显不均匀强化(χ^(2)=25.1,P<0.01)。47例中,增强后轻度强化6例,中度强化8例,明显强化33例,强化程度与肿瘤危险程度无统计学意义(χ^(2)=5.31,P=0.07);低、中、高度危险组不均匀强化分别为2、9、14例,高度危险组不均匀强化明显多于中度危险组(χ^(2)=13.3,P=0.0002),中度危险组明显高于低度危险组(χ^(2)=12.7,P=0.0003)。结论MSCT多期增强检查可预测GIST危险程度,对指导临床治疗和评估预后具有重要的价值。

Objective To analyze the MSCT multiphase enhancement of gastrointestinal stromal tumors and to evaluate its risk.Methods The data of 47 cases of GIST confirmed by surgery and pathology were analyzed retrospectively.All of them underwent multi-phase dynamic enhancement scanning,and the image enhancement was compared with the postoperative pathology.Results In 2 cases with very low risk and 18 cases with low risk,the tumors were all smaller than 5 cm in diameter and of regular shape,of which 19 cases had uniform density,1 case had mild internal cystic degeneration and necrosis,17 cases had uniform enhancement after enhancement,and 3 cases had uneven enhancement.In 12 cases with moderate risk and 15 cases with high risk,the tumors were all larger than 5cm in diameter and more irregular in shape.Among them,21 cases had uneven density and cystic degeneration and necrosis were observed in the lesions.After enhancement,4 cases had uniform enhancement and 23 cases had uneven enhancement.Tumor size and enhancement methods were statistically significant,and tumors that were larger than 5cm had significantly heterogeneous enhancement(χ^(2)=25.1,P<0.01).Among the 47 cases,there were 6 cases with mild enhancement,8 cases with moderate enhancement,and 33 cases with severe enhancement.There was no statistical significance between the degree of enhancement and the degree of tumor risk(χ^(2)=5.31,P=0.07).In the low,medium and high risk groups,the uneven enhancement was 2,9 and 14 cases.The uneven enhancement of high risk group was significantly more than the moderate risk group(χ^(2)=13.3,P=0.0002),and the moderate risk group was significantly more than the low risk group(χ^(2)=12.7,P=0.0003).Conclusion MSCT multistage enhanced examination can predict the risk of GIST,which is of great value in guiding clinical treatment and evaluating prognosis.