多层螺旋CT对胃肠间质瘤治疗效果的评价价值

Value of multi-slice spiral CT in evaluating the therapeutic effect of gastrointestinal stromal tumors

目的探讨多层螺旋CT(MSCT)在胃肠间质瘤(GIST)治疗效果评价中的价值。方法回顾性分析2018年1月~2019年12月于我院接受治疗的42例GIST患者MSCT检查资料,其中34例接受手术治疗,8例不可手术或转移接受分子靶向治疗。分析手术治疗经MSCT随访复发与转移情况;分子靶向治疗经MSCT随访后采用Choi标准评价疗效,并评估病灶的特征。结果接受手术治疗的GIST患者随访时间6~24月,复发12例,平均肿瘤直径1.64±0.49 cm;7例边界清楚,5例浸润生长;8例内部密度均匀,4例发现液化坏死区域;8例外形呈类圆形,4例呈现椭圆形;腔内生长7例,腔外生长5例;8例均匀强化,4例不均匀强化;2例钙化。接受分子靶向治疗的8例患者随访时间为6~24月,其中2例边界清楚,3例边缘光整,3例边缘模糊;6例增强后均匀强化,2例增强后不均匀强化;4例轻度强化,2例中度强化,2例重度强化;均有肿瘤血管;5例伴周围浸润,3例不伴周围浸润。第1次MSCT随访疾病控制率为75.0%,第2次疾病控制率为75.0%,末次疾病控制率为62.5%;伴MSCT随访的进行,GIST患者的肿瘤最长径与静脉期肿瘤CT值均呈现下降,且CT值与基线比较平均下降幅度高于肿瘤长径下降幅度。42例患者治疗后9例出现转移病灶,包含肝脏转移4例,腹腔转移2例,多处转移1例,盆腔转移2例。结论MSCT在胃肠间质瘤治疗效果评价中有良好的应用价值,可为GIST患者手术或分子靶向治疗后的疗效评估及治疗指导提供重要的影像学资料。

Objective To explore the value of multi-slice spiral CT(MSCT)in evaluation of the therapeutic effect of gastrointestinal stromal tumor(GIST).Methods We retrospectivly analyzed the MSCT data of 42 patients with GIST who received treatment in our hospital from January 2018 to December 2019.Thirty-four cases received surgical treatment,8 cases received molecular targeted therapy for inoperable or postoperative recurrence or metastasis.Surgical treatment was followed up by MSCT for recurrence and metastasis.After the follow-up of MSCT for molecular targeted therapy,Choi criteria were used to evaluate the curative effect and evaluate the characteristics of the lesion.Results GIST patients who underwent surgery were followed up for 6 to 24 months.Twelve cases recurred with an average tumor diameter of 1.64±0.49 cm.Seven cases had clear borders and 5 cases infiltrated growth.Eight cases had uniform internal density and 4 case had liquefaction necrosis area.Eight cases had a round shape and 4 cases were oval.Seven cases had intracavitary growth and 5 cases had extracavity growth.Eight cases had uniform strengthening,4 case had inhomogeneous strengthen and 2 cases Calcification.The 8 patients that received molecular targeted therapy were followed up for 6 to 24 months.Among them,2 cases had clear boundaries,3 cases had smooth edges,3 cases had blurred edges.Six cases had uniform enhancement after enhancement,2 cases had uneven enhancement after enhancement.Four cases had mild enhancement,2 cases had moderate enhancement,and 2 cases had severe enhancement.Five cases with peripheral infiltration,3 cases without peripheral infiltration.Five cases showed cystic degeneration and necrosis.The disease control rate of the first MSCT followed-up were 75.0%,the second disease control rate were 75.0%,and the last disease control rate were 62.5%.With the followed-up of MSCT,the CT values of the longest diameter of the tumor and the venous stage tumors of GIST patients decreased.The average decrease of the CT value compared with the baseline was higher than the decrease of the long diameter of the tumor.After treatment,9 cases had metastatic lesions,including 4 cases of liver metastasis,2 cases of abdominal metastasis,1 case of multiple metastases and 2 cases of pelvic metastasis.Conclusion MSCT has a good application value in the evaluation of the therapeutic effect of gastrointestinal stromal tumors.It can provide important imaging data for the evaluation of the efficacy and treatment guidance of GIST patients after surgery or molecular targeted therapy.