超声内镜弹性成像技术与增强CT检查对胃间质瘤的诊断价值比较

Value of endoscopic ultrasound elastography versus contrast-enhanced computed tomography in the diagnosis of gastrointestinal stromal tumors

目的比较超声内镜弹性成像技术(EUS)与增强CT检查对胃间质瘤(GIST)危险程度的诊断价值。方法收集2019年5月至2021年4月于温州市中心医院确诊并行内镜治疗或外科手术的GIST患者77例的临床及影像学资料,术前均采用超声内镜弹性成像5分法以及低张胃肠增强扫描CT两种方式对肿瘤进行危险程度判断。比较两种方法对GIST的术前危险度判断的符合率,并总结EUS及CT的影像学特点。结果术后病理结果高危险度13例,中危险度13例,低危险度35例,极低危险度16例;根据病理结果将其分为低危组(低危险度+极低危险度)和中高危组(高危险度+中危险度)两组。病理低危组共51例患者中,EUS检查42例为低危并建议进行内镜下治疗,9例为中危;增强CT检查30例为低危并建议进行内镜下治疗,21例为中危。病理检查结果中高危组共26例患者中,EUS检查4例为低危,22例符合;增强CT检查9例为低危,17例符合。EUS总符合率为83.11%(64/77),CT总符合率为61.04%(47/77),EUS检查对GIST危险度判断总符合率与CT检查差异有统计学意义(χ^(2)=4.66,P<0.05)。EUS检查预判GIST高危的灵敏度为84.62%,特异度为82.35%,均高于CT检查预判的灵敏度(65.38%)和特异度(58.82%),但两者差异均无统计学意义(灵敏度Fisher确切概率法P=0.590,特异度χ^(2)=0.93,P>0.05)。结论EUS对GIST高危风险评估的总体诊断准确性优于增强CT检查,两者结合更有利于对病变邻近结构及脏器的侵犯、远处转移等情况的全面了解,能为GIST治疗方式的选择提供可靠的参考。

Objective To investigate the clinical value of endoscopic ultrasound elastography versus contrast-enhanced computed tomography in the risk stratification of gastrointestinal stromal tumors(GISTs).Methods Clinical and imaging data were obtained from 77 patients who were confirmed to have GISTs and underwent endoscopic or surgical treatment at Wenzhou Central Hospital between May 2019 and April 2021.Endoscopic ultrasound elastography based on a five-point scoring system and hypotonic gastrointestinal contrast-enhanced computed tomography were performed for preoperative risk stratification of GISTs.The two techniques were compared in terms of the accuracy of preoperative risk stratification of GISTs.The imaging features of the two techniques were summarized.Results According to the postoperative pathological results,13 patients were at high risk,13 patients were at medium risk,35 patients were at low risk,and 16 patients were at extremely low risk.These patients were divided into two groups according to postoperative pathological results:a low-risk group(low risk+extremely low risk)and a medium-and high-risk group(high+medium risk).In the low-risk group(n=51),42 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs and were recommended to receive endoscopic treatment,while the rest 9 patients were identified to have medium-risk GISTs.Contrast-enhanced computed tomography findings revealed that 30 patients had low-risk GISTs and were recommended to receive endoscopic treatment,and 21 patients had medium-risk GISTs.In the medium-and high-risk group(n=26),4 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs,and 22 patients had medium-or high-risk GISTs.Contrast-enhanced computed tomography findings revealed that 9 patients were identified to have low-risk GISTs,and 17 patients had medium-or high-risk GISTs.Endoscopic ultrasound elastography yielded an overall diagnostic accuracy of 83.11%(64/77),while contrast-enhanced computed tomography had an overall diagnostic accuracy of 61.04%(47/77).Endoscopic ultrasound elastography outperformed contrast-enhanced computed tomography in accurate risk stratification of GISTs(χ^(2)=4.66,P<0.05).In terms of predicting high-risk GISTs,endoscopic ultrasound elastography had a sensitivity of 84.62%and a specificity of 82.35%,both were higher than those of contrast-enhanced computed tomography(sensitivity:65.38%;specificity:58.82%),but the differences in sensitivity and specificity between the two techniques were not significant(sensitivity:Fisher's exact test P=0.590,specificity:χ^(2)=0.93,P>0.05).Conclusion Endoscopic ultrasound elastography appears to have a better overall diagnostic accuracy in the risk stratification of GISTs compared with contrast-enhanced computed tomography.The combined use of these two techniques may offer a better comprehensive understanding of the perilesional structure and organ involvements and distant metastasis than a single technique,thereby providing a reliable reference for the choice of treatment for GISTs.