胃平滑肌肿瘤的影像学诊断

Imagiologic Diagnosis of Gastric Smooth Muscle Tumors

目的:探讨胃平滑肌肿瘤的影像学诊断价值和限度。材料和方法:经手术病理或(和)活检证实的胃平滑肌瘤17例,平滑肌肉瘤21例。回顾性分析其影像学表现特征。结果:平滑肌肿瘤X线诊断的准确性为74.1％(20/27)。腔内型15例,表现为圆形或卵圆形向腔内突出的肿块,并伴溃疡形成(9/15)。腔外型7例,为胃壁的受压变形;混合型5例,兼有上述两型表现。CT定性诊断为86.4％(19/22),定位诊断为95.5％(21/22),10例平滑肌瘤直径多在5cm内(80％),表现为圆形或椭圆形软组织肿块,境界清楚,密度多均匀(80％),明显强化。12例平滑肌肉瘤中表现为不规则分叶状肿块者11例(91.7％),倾向于腔外或偏心性生长,肿块内不规则低密度坏死区(83.3％),实质明显不均匀强化。肿块直径多大于5cm(83.3％)。结论:CT扫描在胃平滑肌肿瘤的诊断及鉴别诊断上有重要价值,明显优于钡餐检查。

Purpose: To investigate the imagiologic diagnostic value and limitation of gastric smooth muscle tumors. Materials and Methods: Imagiologic feature of leiomyoma 17 cases, leiomyosarcoma 21 cases which performed by operation/ pathology and biopsy were analyzed retrospectively. Results: The diagnostic accuracy rate of X - ray was 74.1% (20/27), X - ray freature were as following: Intraluminal type (15 cases) had a protruding into intraluminal round or ovoid mass with ulcer(9/15); extraluminal type(7 cases) had a extrapressure deformity of gastric contour; mixed type(5 cases) had two of above.The quality diagnostic accuracy rate of CT is 86.4% (19/ 22), The diagnostic accuracy rate of site location of CT is 100% .Round or ovoid soft tissue mass, distinct margin, uniform density(80%), obvious contrast enhance were seen in the 10 cases with gastric leiomyoma. Most lesions were less than 5 cm in diameter (80%) . 12 cases with leiomyosarcoma, CT showed irregular lobulated mass(91.7%), exophytic or eccentric growth pattern, irregular low - density necrotic areas(83.3% ) and obvious heterogeneous enhance.Most lesions were larger than 5 cm in diameter(83.3%) .Conclusion: CT scan is valuable in the diagnosing and differentiating of gastric smooth muscle tumors. It is specially superior to barium meal examination for exophytic gastric smooth muscle tumors.