肿瘤优势供血动脉及胃周血管移位征对胃源性外生型肿瘤定位诊断价值

The value of tumor predominant feeding artery and perigastric vessels displacement sign in localization of exophytic tumors of gastric origin

目的:探讨MSCT上肿瘤优势供血动脉及肿瘤与胃周血管的关系对胃源性外生型肿瘤的定位诊断价值。方法:回顾性分析经手术病理证实起源于胃或其周围器官组织的外生型肿瘤73例(胃起源肿瘤39例,胃周围器官组织起源肿瘤34例),观察识别肿瘤优势供血动脉及肿瘤与胃周血管的关系。同时测量肿瘤最大径及动静脉期CT值,记录术前血清CEA、CA19-9水平。结果:病变边缘胃周血管显示"内移位"中,非胃肿瘤组(20/22)明显多于胃源性肿瘤组(2/22),显示"外移位"中,胃源性肿瘤组(26/30)明显多于非胃肿瘤组(4/30),差异有统计学意义(P<0.001)。胃源性肿瘤组优势供血动脉多来源于胃动脉系统,非胃肿瘤组优势供血动脉多来源于其它动脉系统,差异有统计学意义(P<0.001)。两组肿瘤的最大径、动静脉期CT值、术前血清CEA水平差异均无统计学意义。胃源性肿瘤组术前血清CA19-9水平低于非胃肿瘤组,差异有统计学意义(P<0.001)。结论:据MSCT肿瘤优势供血动脉以及肿瘤与胃周血管的关系可辅助胃源性外生型肿瘤的定位诊断。

Objective:To investigate the value of multi-slice spiral CT-based tumor predominant feeding artery sign and the relationship between tumor and perigastric vessels in localization of exophytic tumors of gastric origin.Methods:The CT images of 73 patients with pathologically proven exophytic tumors from stomach and perigastric organs or tissue(tumors of gastric origin,n=39;perigastric organ or tissue original tumors,n=34)were retrospectively analyzed.Image analysis was focused on identifying the tumor predominant feeding artery and the relationship between tumor and perigastric vessels.The maximum diameters and CT values(HU)on arterial and venous phases were measured.The preoperative serum of CEA and CA19-9 were recorded.Results:Among the cases of demonstrating"internal shift"of the perigastric vessels adjacent to the masses,perigastric organ or tissue original tumors(20/22)were much more than tumors of gastric origin(2/22),while in the cases of demonstrating"external shift",tumors of gastric origin(26/30)were much more than perigastric organ or tissue original tumors(4/30),P<0.001.The predominant feeding artery of most tumors of gastric origin originated from gastric arteries,while those of most perigastric organ or tissue original tumors originated from other arteries(P<0.001).The was no statistical significance demonstrated in maximum diameters,CT values of both arterial and venous phases,and preoperative serum CEA.The preoperative serum of CA19-9 was lower in patients with tumors of gastric origin(P<0.001).Conclusion:Identifying the predominant feeding artery sign and the relationship between tumor and perigastric vessels on MSCT can facilitate in localization of exophytic tumors of gastric origin.