胃神经鞘瘤的CT表现

CT features of gastric schwannoma

目的探讨胃神经鞘瘤(GS)的CT表现特征,以提高对该病的认识。方法选取33例经手术病理证实的GS患者的临床和CT资料,评估肿瘤的位置、大小、形态、边缘、生长方式、强化方式及程度、肿瘤被覆黏膜面有无溃疡、肿瘤内部有无囊变坏死、钙化、瘤周淋巴结情况及患者临床症状;按肿瘤最大径(Dmax,≥5 cm和<5 cm)分成两组并对其CT征象进行统计学分析。结果33例GS均为单发,以胃体大弯侧多见,占60.6%(20/33),以腔外生长为主,占51.5%(17/33),肿瘤Dmax为(4.39±2.01)cm(≥5 cm者12例、<5 cm者21例)。27例肿瘤呈类圆形或卵圆形,6例呈不规则形。32例肿瘤边缘清晰,1例边缘稍模糊。10例肿瘤黏膜面可见溃疡形成,5例瘤内可见囊变坏死、6例瘤内可见钙化。25例肿瘤周围可见多发大小不等的淋巴结,多数呈明显均匀强化,部分不规则淋巴结可见淋巴门结构。27例肿瘤行增强扫描均呈渐进性强化,其中15例呈轻中度强化,6例呈明显强化。两组间肿瘤的形态和瘤内囊变坏死差异有统计学意义(P<0.05),而两组间年龄、性别、症状、位置、生长方式、表面溃疡、钙化和瘤周淋巴结情况差异无统计学意义(P>0.05)。结论GS的CT表现具有一定的特征性,其中肿瘤呈轻中度均匀渐进性强化和瘤周伴有多发大小不等明显强化的淋巴结最具有提示作用。

Objective To investigate the CT features of gastric schwannoma,and to improve the awareness of the disease.Methods The clinical and CT data of 33 patients with gastric schwannoma confirmed by surgery and pathology were retrospectively analyzed to evaluate the location,size,shape,edge,growth mode,enhancement mode and degree of the tumor,whether the focal mucosal surface had ulcer,whether the tumor had necrosis,whether the tumor had calcification,and the changes of the lymph nodes around the tumor.According to the maximum diameter(Dmax)of tumor,the patients were divided into two groups(≥5 cm and<5 cm)and the CT signs of each group were analyzed respectively.Results All of the 33 tumors were solitary,60.6%(20/33)of them involved the greater curvature of the gastric body,the extraluminal growth pattern was found in 51.5%(17/33)of them,and the meanDmaxof the tumors was(4.39±2.01)cm(12 cases≥5 cm,21 cases<5 cm).The masses were shown to be round or ovoid in 27 cases and irregular in 6 cases.The margin of the masses were well-defined in 32 cases and ill-defined in 1 case.The mucosal surface of the tumors was ulcerated in 10 cases,cystic necrosis was detected in 5 cases,and calcification was observed in 6 cases.Multiple lymph nodes with different sizes were observed around the masses in 25 cases,most of them showed obvious uniform enhancement,and some irregular lymph nodes showed hilar structures.On contrast-enhanced CT images,27 tumors presented progressive enhancement,of which 15 cases were mildly to moderately enhanced and 6 were markedly enhanced.There were statistically significant differences in massshapeand intratumoral cystic necrosis between the two groups(P<0.05),while there was no statistically significant difference in age,gender,symptoms,location,growth pattern,ulcer,calcification,or changes of lymph nodes between the two groups(P>0.05).Conclusion The CT findings of the GS have some characteristics.Mild to moderate progressive enhancement of the tumor and multiple markedly-enhanced lymph nodes with different sizes around the tumor can imply the diagnosis of GS.