胃肠道外间质瘤的影像诊断及鉴别诊断体会

Experience of imaging diagnosis and differential diagnosis of extragastrointestinal stromal tumor

目的:研究探讨胃肠癌间质瘤的影像学诊断及鉴别的方法及应用价值。方法:收治胃肠道外间质瘤患者12例,所有患者均经手术病理证实,回顾性分析患者的基本临床资料,观察患者的CT诊断结果和影像学特征,分析其临床应用价值。结果:12例患者均为单发病灶,其中病灶位于腹腔后5例,位于腹腔内大网膜3例,位于肠系膜4例。肿瘤的最大平均直径(16.9±3.2)cm。病灶直径较小的,边缘光滑整洁,呈类圆形,与周围组织结构之间的界限清晰,血供丰富;病灶直径较大的患者,边缘多见分叶,呈分叶状和不规则状,与周围组织结构之间的界限相对模糊,血供丰富,病灶内存在低密度坏死区,密度多不均匀,经增强扫描可见病灶实质部分出现不同程度的强化,囊变或者坏死的部分未见强化发生。患者中均可见肿瘤对周围组织结构有一定程度的压迫或者转移情况,其中与周围组织结构之间发生粘连9例,发生淋巴结、脏器转移5例,与病理诊断结果进行对照可见,诊断准确率50.0%,误诊率16.7%。结论:胃肠道外间质瘤的影像学表现有一定的特征性,能为患者的临床诊断提供有价值的诊断信息,为与其他腹膜后常见肿瘤的鉴别提供依据。

Objective:To explore the imaging diagnosis and differential diagnosis and application value of extragastrointestinal stromal tumor.Methods:12 cases of gastrointestinal interstitialoma patients were selected.All patients were confirmed by operation pathology.Basic clinical data were retrospectively analyzed.We observed the CT diagnosis results and characteristics of imaging,and analyzed the clinical application value.Results:12 patients were single lesions,the lesions were located in after the abdominal cavity of 5 cases,in the omental intraperitoneally in 3 cases,in the mesentery of 4 cases.The maximum average tumor diameter was(16.9±3.2)cm.The lesion diameter was smaller,the edge was smooth and clean,it was round,the distinction was clear with the surrounding tissue,blood supply was rich;for patients with larger diameter of lesions,the edge was divided leaves,the distinction was relatively vague with surrounding structures,the blood supply was abundant,there was low density necrosis in the focus,most density were not homogeneous,enhanced scanning showed that there were different degree enhancement in the substantial part of the lesion,cystic change or there was no enhancement in necrotic part.In all patients,the tumor had a certain degree of compression for surrounding tissue structure or metastasis,there was adhesion with surrounding tissue structure in 9 cases,lymph node and organs metastasis were in 5 cases,compared with the pathological diagnosis results,the accuracy rate of diagnosis was50%,the rate of misdiagnosis was 16.7%.Conclusion:Imaging findings of extragastrointestinal stromal tumor had certain characteristics.It can provide valuable diagnostic information for clinical diagnosis of patients,and it can provide the basis for the identification with other common retroperitoneal tumor.