多层螺旋CT在胃肠间质瘤危险度无创评估中的应用价值

Value of multislice CT applied in the non‑invasive assessment of the risk of gastrointestinal stromal tumors

目的:分析胃肠道间质瘤(GISTs)的多层螺旋CT(MSCT)影像学表现,并探讨不同影像学特征与其生物学危险度之间的关系。方法:回顾性分析2017年2月至2022年1月期间在孝感市第一人民医院就诊并临床诊断为GISTs患者82例,最终经病理证实为GISTs且具有完整螺旋CT平扫及多期增强扫描资料者70例。分析所有患者的CT影像特征,包括:肿瘤发生部位、最大径、生长方式、形状、边界、强化程度、强化模式、有无出血坏死、有无钙化及转移等。患者根据病理危险度分为极低危、低危、中危、高危,比较不同危险分级之间影像特征差异。结果:70例病理确诊患者均为单发病灶,分布在胃、小肠、结直肠、肠系膜及网膜的病灶分别有41例(58.6%)、18例(25.7%)、7例(10%)、2例(2.85%)和2例(2.85%);病理危险度分级显示极低危、低危、中危及高危患者分别有6例、35例、20例和9例。MSCT对GISTs发生部分的定位诊断与病理结果具有很好的一致性。GISTs的MSCT影像学表现具有多样化特征,GISTs的危险度在肿瘤的发生部位、最大径、形态、强化方式、有无出血坏死、钙化及转移方面差异有统计学意义(P<0.05),而在肿瘤的生长方式、边界及强化程度方面差异未见明显统计学意义(P>0.05)。结论:不同危险程度的胃肠间质瘤MSCT影像学表现存在一定的差异,尤其是肿瘤发生部位、最大径、形态及强化方式等征象在GISTs治疗前生物学危险性的无创评估中具有较高的应用价值。

Objective:To analyze the multislice CT(MSCT)imaging presentation of gastrointestinal stromal tumors(GISTs)and to explore the relationship between different imaging features and their biological risk.Methods:A retrospective analysis was performed on 82 patients who were clinically diagnosed with GISTs between February 2017 and January 2022,in Xiaogan First People's Hospital,and 70 patients of them had complete spiral CT plain scan and multi-phase enhancement scan data.CT imaging features of all the patients were analyzed,including the site of the tumor,maximum diameter,growth pattern,shape,border,degree of enhancement,enhancement pattern,presence of hemorrhagic necrosis,presence of calcification,and metastases.The patients were classified into very low risk,low risk,intermediate risk,and high risk according to their pathological risk level.Results:All 70 pathologically confirmed patients had a single lesion,with 41(58.6%),18(25.7%),7(10%),2(2.85%),and 2(2.85%)lesions in the stomach,small intestine,colorectum,mesentery,and omentum,respectively;the pathological risk classification showed that 6,35,20 and 9 patients were at very low,low,medium and high risk,respectively.The localization of GISTs by MSCT was in good agreement with the pathological findings.The MSCT imaging manifestations of GISTs had diverse features.Statistically significant differences were found in the risk level of GISTs in terms of tumor location,maximum diameter,morphology,mode of enhancement,presence of haemorrhagic necrosis,calcification and metastasis(P<0.05).However,there were no statistically significant differences in tumor growth pattern,border,and degree of enhancement(P>0.05).Conclusion:There are some differences in the MSCT imaging performance of gastrointestinal mesenchymal tumors with different risk levels,especially the signs of tumor location,maximum diameter,morphology,and enhancement pattern with high value in the non-invasive assessment of the biological risk of GISTs before treatment.