起源自小肠系膜胃肠道外间质瘤的CT表现

Spiral CT Features of EGIST in Small Bowl Mesentery

目的探讨小肠系膜源性胃肠道外间质瘤(EGIST)的螺旋CT表现特征。方法回顾性分析19例经病理证实的小肠系膜EGIST的CT表现特征及肿块部位,尤其是肿块与肠系膜上动脉、上静脉、小肠、小肠系膜血管的关系。结果 19例均为体积较大的单发囊实性肿块;4例显示肠系膜上动脉和上静脉移位,7例表现为十二指肠水平段向后方、左侧移位,肿块包绕邻近的肠系膜血管6例;16例在肿块与邻近的小肠之间显示小肠系膜缘的血管弓;肿块包绕邻近小肠肠管4例。CT平扫均可见不均匀的软组织密度肿块;增强扫描肿块内显示明显的囊变、坏死,其囊壁和/或实性部分呈持续强化。结论小肠系膜EGIST根据其肿块的CT特征及其与邻近肠管和血管的关系,可作出定位诊断以及一定程度的定性诊断,从而有助于临床治疗。

Objective To evaluate the spiral CT features of the extra-gastrointestinal stromal tumors(EGIST) located in the small bowel mesentery. Methods The CT manifestations of the mesenteric EGIST and the location of the masses in 19 cases identified by surgery and pathology were retrospectively reviewed and analyzed. Especially the displacement and direction of the superior mesenteric artery, superior mesenteric vein, the small bowel, and mesenteric vessels. Results All of 19 cases were presented as a solitary cystic solid huge mass. The superior mesenteric artery and vein were displaced in 4 cases. The horizontal part of the duodenum is displaced to the rear left in 7 cases. The mesenteric vessels were encased by amass in 6 cases. 16 cases showed a vascular arch of the small mesenteric margin between the mass and the adjacent small intestine. The adjacent local small bowel was encased by mass in 4 cases. On the plain CT images, the masses were displayed as heterogeneous soft tissue density solid-cystic mass. On the contrast-enhanced CT images, most of the masses showed significant cystic changes and necrosis within the mass, with heterogenous progressive enhancement in the cystic wall and/or solid portion of the mass. Conclusion The CT manifestations including the signs of small bowel mesentery EGIST,relationship with vessels and adjacent bowels are very helpful in making apreliminary diagnosis and qualitative diagnosis to a certain extent thus contributing to clinical treatment.