胃肠道间质瘤临床、MSCT特征与病理危险度分级的相关性分析

Correlative Analysis of Clinical、MSCT Features and Risk Assessment of Gastrointestinal Stromal Tumors

目的探讨胃肠道间质瘤(GISTs)的临床、多层螺旋CT(MSCT)影像学特征与病理危险度分级的相关性。方法回顾性分析2017年1月至2020年2月期间经手术或病理确诊的97例GISTs患者临床资料、MSCT的影像学表现及病理危险度分级,包括患者性别、年龄、肿瘤发生部位、形态、最大径、密度、钙化、边界、生长方式、溃疡、强化程度、肿瘤实性成分最大CT值[平扫(UP)、动脉期(AP)、静脉期(VP)、延迟期(DP)]及强化相对值[(AP-UP)/UP×100%、(VP-AP)/AP×100%、(DP-VP)/VP×100%、(VP-UP)/UP×100%、(DP-UP)/UP×100%、(DP-AP)/AP×100%],病理危险度分级参照美国国立卫生研究院(NIH)原发GISTs切除后的风险分级(NIH 2008版)分为极低危险组、低度危险组、中度危险组及高度危险组,将极低、低、中度危险度纳入低度危险组,高危险度纳入高度危险组,分析MSCT表现与病理危险度分级的相关性。结果 97例GISTs中,低度危险组51例,高度危险组46例,统计学分析发现,患者性别、年龄、肿瘤发生部位、形态、最大径、密度、溃疡、边界、生长方式、强化程度、肿瘤实性成分最大CT值的强化相对值[AP、VP、(AP-UP)/UP×100%、(VP-UP)/UP×100%、(DP-AP)/AP×100%]在两组危险度分级间存在统计学差异(P均<0.05),其中,综合分析患者性别、肿瘤形态、边界,肿瘤实性成分最大CT值的强化相对值[(VP-UP)/UP×100%]这4个参数能较好地鉴别肿瘤危险程度[P<0.001,曲线下面积(AUC)=0.917,95%CI(0.859,0.974)]。结论 GISTs MSCT表现有一定特征,临床及影像学特征分析可以评估肿瘤的危险程度。

Objective To investigate the relationship between Clinical and MSCT(multi-slice CT) imaging features and risk assessment of gastrointestinal stromal tumors(GISTs). Methods The Clinical and MSCT features of 97 patients with GISTs surgically or pathologically proved from January 2017 to February 2020 were analyzed, and the relationship between Clinical、MSCT features and risk assessments were analyzed.The Clinical and MSCT features included: gender and age of the patients, site, contour, the larger diameter, necrosis, calcification, boundary, ulceration, growthpattern, degree of enhancement, CT value of solid component of tumor(unenhanced phase, UP, arterialphase, AP, venousphase, VP, delayedphase, DP) and percentage of relative enhanced CT value of tumorsolid component [(AP-UP)/UP×100%、(VP-AP)/AP×100%、(DP-VP)/VP×100%、(VP-UP)/UP×100%、(DP-UP)/UP×100%、(DP-AP)/AP×100%].According to the pathological risk classification of the primary GISTs after resection of United States National Institutes of Health(NIH 2008),the cases were divided into four groups including very low, low, moderate and high riskgroup, we renamed the very low, low and moderate risk groups as the relative low risk group, andhigh risk group as the relative high riskgroup, and analyzed the correlation of MSCT manifestations and pathological risk classification. Results Classification of pathological risk of the 97 patients with GIST were 51 cases of relative low risk grade and 46 cases of relative high risk grade.Statistical analysis showed that gender, age, tumorlocation, contour, the larger diameter, density, ulceration, boundary, growthpattern, enhancementdegree, and relative enhancement value[AP,VP,(AP-UP)/UP×100%,(VP-UP)/UP×100%,and(DP-AP)/AP×100%]of the maximum CT value of tumorous solid components had statistical differences between the two groups(all P<0.05). Comprehensiveanalysis of 4 parameters among them, including patient gender, tumorcontour, boundary and relative enhancement value[(VP-UP)/UP×100%]of maximum CT value of tumorous solid components, could better identify the degree of tumor risk[P<0.001,AUC=0.917,95% CI(0.859,0.974)]. Conclusion MSCT image features of GISTs had certain characteristics. Clinical and radiographic feature analysis could assess the risk degree of the tumor.