超声内镜与CT对上消化道黏膜下肿瘤诊断价值比较研究

Comparison of endoscopic ultrasonography and CT in the diagnosis of submucosal tumors of upper digestive tract

目的分析比较超声内镜(endoscopic ultrasonography,EUS)与CT对上消化道黏膜下肿瘤(submucosal tumors,SMTs)的诊断价值。方法回顾性分析107例上消化道SMTs患者的术前EUS及CT检查资料,以手术病理为金标准,比较两者对SMTs的影像学特点及对不同长径SMTs的诊断价值。结果良性SMTs与间质瘤在肿瘤位置、表面黏膜、起源层、回声特点及特异表现、多普勒血流信号等差异有统计学意义(P<0.05);对于长径<20 mm的肿瘤CT检出阳性率仅9.62%,EUS诊断准确性为84.62%;长径20~50 mm的肿瘤CT阳性率为67.39%,增强CT对检出肿瘤诊断准确性为82.60%,EUS诊断准确性诊断准确性为91.30%,差异无统计学意义(P>0.05);长径>50 mm增强CT诊断准确性88.89%,EUS诊断准确性为100%,差异无统计学意义(P>0.05)。结论EUS在不同长径SMTs均具有较高诊断价值,尤其是对长径<50 mm者明显优于CT,联合CT可帮助制定更优治疗措施。

Objective To analyze the diagnostic value of endoscopic ultrasonography(EUS)and CT in submucosal tumors(SMTs)of upper digestive tract.Methods Retrospectively analyzed the preoperative EUS and CT data of 107 patients with upper gastrointestinal SMTs,evaluating the imaging features and the diagnostic value of different diameters SMTs between EUS and CT as the gold standard of pathological diagnosis.Results There were significant statistical differences between benign SMTs and gastrointestinal stromals in the tumor location,surface mucosa,growth pattern,origin layer characteristics,internal echo,specific manifestations and blood flow.In diameter<20 mm,the positive rate of CT detection was only 9.62%,and the diagnostic accuracy of EUS was 84.62%.In diameter between 20 mm and 50 mm,the positive rate of CT detection was 67.39%,the diagnostic accuracy of enhanced CT was 82.60%,and EUS was 91.30%,without statistical significance(P>0.05).In diameter>50 mm,the diagnostic accuracy of enhanced CT was 88.89%,and EUS was 100%,without statistical significance(P>0.05).Conclusion The diagnostic value of EUS for SMTs with different diameters of upper digestive tract is higher than that of CT,especially for those with diametres<50 mm.EUS combined CT may help to develop better treatment.