探讨胃肠道间质瘤CT增强影像学征象与核分裂象计数之间的关系

Correlative Analysis of Imaging Findings on Enhanced-CT and the Mitotic Value of Gastrointestinal Stromal Tumors

目的探讨胃肠道间质瘤(GISTs)临床病理资料、CT增强影像学征象与核分裂象计数之间的关系。方法回顾性分析术后病理证实为GISTs患者的临床病理及影像资料,临床资料包括年龄、性别、临床症状,病理资料包括参照美国国立卫生研究院2008年改良版标准的危险度分级、Ki-67指数、核分裂象计数,将核分裂象计数分为≤5/50高倍视野(HPF)为A组,>5/50HPF为B组。评估GISTs的影像学征象,包括病灶大小、原发部位、形态、边界、密度、瘤内/瘤周增粗血管、钙化、转移情况及肿瘤内实性成分在增强各期的平均CT值并计算强化相对率,包括(动脉期-平扫)/平扫×100%,(门静脉期-平扫)/平扫×100%,(门静脉期-动脉期)/动脉期×100%。结果共178例GIST,男女比例为1∶1,平均年龄(60.4±12.6)岁。Ki-67指数与核分裂象计数分组差异有统计学意义(χ^(2)=36.5,P<0.001)且具有中等程度相关性(r=0.45,P<0.05)。GISTs的肿瘤形态、内部坏死在两组核分裂象计数中有统计学差异(P<0.05)且均呈极弱或无相关关系(r=0.18,P<0.05)。余影像学参数在核分裂象A组和B组均无统计学差异(P>0.05)。结论在CT增强上,GIST表现出肿瘤形态不规则、内部坏死,在核分裂象计数>5/50HFP更多见,对于GISTs的危险度分级有一定的提示意义。

Objective To explore the relationship between clinic and pathologic data,imaging findings on enhanced-CT and mitotic value of gastrointestinal stromal tumors(GISTs).Methods The clinical,pathological and imaging data of patients with gastrointestinal stromal tumors(GISTs)after surgery was retrospectively reviewed and analyzed.The clinical data included age,gender,clinical symptoms.The risk classification,Ki-67 index and mitotic value were based on the revised version of the United States National Institutes of Health(NIH)in 2008.The mitotic value was divided into≤5/50 high power field(HPF)as group A and>5/50 HPF as group B.To evaluate the imaging signs of GISTs,including the size,primary site,morphology,boundary,density,intratumoral/peritumoral of blood vessels,calcification,metastasis,and the CT value of solid components of GISTs and percentage of relative enhanced CT value,including(arterial phase-unenhanced phase)/unenhanced phase×100%,(portal phase-unenhanced phase)/unenhanced phase×100%,(portal phase-arterial phase)/arterial phase×100%.Results A total of 178 patients with GISTs were analyzed.the Ki-67 index and mitotic value of GISTs was statistically different(χ^(2)=36.5,P<0.001)with a moderate correlation(r=0.45,P<0.05).The tumor morphology and internal necrosis of GISTs were statistically different in mitotic value between the two groups(P<0.05)with a weak or no correlation(r=0.18,P<0.05).except for tumor morphology and internal necrosis,there were no statistically significant differences in the other imaging parameters in the two groups(P>0.05).Conclusion On CT enhancement,irregular morphology and internal necrosis are more commonly seen in the mitotic value>5/50 HFP in GISTs,which is helpful to assess the risk classification of GISTs.