多层螺旋CT增强扫描对原发性小肠肿瘤诊断的临床价值

Diagnostic and differential diagnostic value of multilayer spiral CT enhancement scan for primary small bowel tumors

目的 探讨多层螺旋CT(MSCT)增强扫描在原发性小肠肿瘤中的诊断价值。方法 选取经腹部增强CT检查并经病理证实的89例原发性小肠肿瘤患者的影像临床特征。结果 89例中腺癌(SIA)34例,间质瘤(GIST)22例,淋巴瘤(PSIL)18例,神经内分泌肿瘤(NEN)15例。SIA比GIST、PSIL和NEN更多发于十二指肠,GIST比SIA、PSIL和NEN更多发于空肠,PSIL和NEN比SIA和GIST更多发于回肠,差异均有统计学意义(P<0.01);SIA最大径多小于GIST和PSIL(P<0.01)。SIA多边界模糊,GIST多边界清晰(P<0.01)。GIST动脉期和静脉期强化率高于SIA和PSIL;NEN动脉期强化率高于SIA和PSIL,静脉期强化率高于PSIL,差异有统计学意义(P<0.01)。GIST和NEN廓清率均高于SIA和PSIL,差异有统计学意义(P<0.01)。GIST比NEN更容易发生瘤内坏死,GIST比PSIL更容易伴发溃疡,SIA和PSIL比GIST和NEN更容易合并周围淋巴结肿大,SIA比GIST、PSIL、NEN更容易发生肝转移,差异均有统计学意义(P<0.01)。不同病理类型肿瘤形态、延迟期强化率、瘤内钙化及瘤内出血比较差异均无统计学意义(P>0.05)。结论 MSCT增强扫描对原发性小肠肿瘤的诊断及鉴别诊断具有重要价值。

Objective To evaluate the value of multi-slice spiral CT(MSCT) enhanced scan in the diagnosis of primary small intestinal tumors. Methods The imaging and clinical data of 89 cases of primary small intestinal tumors confirmed by pathology by transabdominal contrast-enhanced CT were analyzed retrospectively. Results Among the 89 patients, there were 34 cases of small intestinal adenocarcinoma(SIA), 22 cases of small intestinal stromal tumor(GIST), 18 cases of primary small intestinal lymphoma(PSIL), and 15 cases of intestinal neuroendocrine neoplasm(NEN). SIA was more common in duodenum than GIST, PSIL and NEN;GIST was more common in jejunum than SIA, PSIL and NEN;PSIL and NEN were more common in ileum than SIA and GIST, and the differences were statistically significant(P<0.01). The maximum diameter of SIA was much smaller than GIST and PSIL(P<0.01). SIA had blurred borders while GIST had clear borders(P<0.01). The enhancement rate of GIST in arterial phase and venous phase was higher than that in SIA and PSIL;NEN, and that in arterial phase was higher than that in SIA and PSIL, and that in venous phase was significantly higher than that in PSIL;the difference was statistically significant(P<0.01). The clearance rate of GIST and NEN was significantly higher than that of SIA and PSIL, and the difference was statistically significant(P<0.01). GIST was more prone to intratumoral necrosis than NEN, GIST was more likely to accompany ulcers than PSIL, SIA and PSIL were more likely to be associated with enlarged peripheral lymph nodes than GIST and NEN, and SIA was more likely to have liver metastasis than GIST, PSIL and NEN, the difference was statistically significant(P<0.01). There was no significant difference in morphology, delayed enhancement rate, intratumoral calcification and intratumoral hemorrhage among different pathological types of tumors(P>0.05). Conclusion Enhanced MSCT scan is of great value in the diagnosis and differential diagnosis of primary small intestinal tumors.