Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps,and gastric stromal tumor risk stratification assessment

BACKGROUND The biological characteristics of gastric stromal tumors are complex,and their incidence has increased in recent years.Gastric stromal tumors(GST)have potential malignant tendencies,and the probability of transformation into malignant tumors is as high as 20%-30%.AIM To investigate the value of multi-slice spiral computed tomography(MSCT)in the differential diagnosis of GST and benign gastric polyps,and GST risk stratification assessment.METHODS We included 64 patients with GST(GST group)and 60 with benign gastric polyps(control group),confirmed by pathological examination after surgery in PLA General Hospital,from January 2016 to June 2021.The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared.According to the National Institutes of Health’s standard,GST is divided into low-and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values.RESULTS The incidences of extraluminal growth,blurred boundaries,and ulceration in the GST group were significantly higher than those in the control group(P<0.05).The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group(P<0.05).The MSCT differential diagnosis of GST and gastric polyp sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and areas under the curve(AUCs)were 73.44%,83.33%,26.56%,16.67%,0.784,respectively.The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value,with a statistical difference.The results showed that the sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%,62.20%,19.82%,37.80%,and 0.710,respectively.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%,60.40%,32.37%,39.60%,and 0.710,respectively.The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group(P<0.05).The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group(P<0.05).CONCLUSION Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.

Deep learning model combined with computed tomography features to preoperatively predicting the risk stratification of gastrointestinal stromal tumors

BACKGROUND Gastrointestinal stromal tumors(GIST)are prevalent neoplasm originating from the gastrointestinal mesenchyme.Approximately 50%of GIST patients experience tumor recurrence within 5 years.Thus,there is a pressing need to accurately evaluate risk stratification preoperatively.AIM To assess the application of a deep learning model(DLM)combined with computed tomography features for predicting risk stratification of GISTs.METHODS Preoperative contrast-enhanced computed tomography(CECT)images of 551 GIST patients were retrospectively analyzed.All image features were independently analyzed by two radiologists.Quantitative parameters were statistically analyzed to identify significant predictors of high-risk malignancy.Patients were randomly assigned to the training(n=386)and validation cohorts(n=165).A DLM and a combined DLM were established for predicting the GIST risk stratification using convolutional neural network and subsequently evaluated in the validation cohort.RESULTS Among the analyzed CECT image features,tumor size,ulceration,and enlarged feeding vessels were identified as significant risk predictors(P<0.05).In DLM,the overall area under the receiver operating characteristic curve(AUROC)was 0.88,with the accuracy(ACC)and AUROCs for each stratification being 87%and 0.96 for low-risk,79%and 0.74 for intermediate-risk,and 84%and 0.90 for high-risk,respectively.The overall ACC and AUROC were 84%and 0.94 in the combined model.The ACC and AUROCs for each risk stratification were 92%and 0.97 for low-risk,87%and 0.83 for intermediate-risk,and 90%and 0.96 for high-risk,respectively.Differences in AUROCs for each risk stratification between the two models were significant(P<0.05).CONCLUSION A combined DLM with satisfactory performance for preoperatively predicting GIST stratifications was developed using routine computed tomography data,demonstrating superiority compared to DLM.

Preoperative prediction of malignant potential of 2-5 cm gastric gastrointestinal stromal tumors by computerized tomography-based radiomics

BACKGROUND The use of endoscopic surgery for treating gastrointestinal stromal tumors(GISTs)between 2 and 5 cm remains controversial considering the potential risk of metastasis and recurrence.Also,surgeons are facing great difficulties and challenges in assessing the malignant potential of 2-5 cm gastric GISTs.AIM To develop and evaluate computerized tomography(CT)-based radiomics for predicting the malignant potential of primary 2-5 cm gastric GISTs.METHODS A total of 103 patients with pathologically confirmed gastric GISTs between 2 and 5 cm were enrolled.The malignant potential was categorized into low grade and high grade according to postoperative pathology results.Preoperative CT images were reviewed by two radiologists.A radiological model was constructed by CT findings and clinical characteristics using logistic regression.Radiomic features were extracted from preoperative contrast-enhanced CT images in the arterial phase.The XGboost method was used to construct a radiomics model for the prediction of malignant potential.Nomogram was established by combing the radiomics score with CT findings.All of the models were developed in a training group(n=69)and evaluated in a test group(n=34).RESULTS The area under the curve(AUC)value of the radiological,radiomics,and nomogram models was 0.753(95%confidence interval[CI]:0.597-0.909),0.919(95%CI:0.828-1.000),and 0.916(95%CI:0.801-1.000)in the training group vs 0.642(95%CI:0.379-0.870),0.881(95%CI:0.772-0.990),and 0.894(95%CI:0.773-1.000)in the test group,respectively.The AUC of the nomogram model was significantly larger than that of the radiological model in both the training group(Z=2.795,P=0.0052)and test group(Z=2.785,P=0.0054).The decision curve of analysis showed that the nomogram model produced increased benefit across the entire risk threshold range.CONCLUSION Radiomics may be an effective tool to predict the malignant potential of 2-5 cm gastric GISTs and assist preoperative clinical decision making.

Gastric schwannoma misdiagnosed as gastrointestinal stromal tumor by ultrasonography before surgery:A case report

BACKGROUND Gastric origin tumors were diagnosed and evaluated preoperatively by gastroscopy,endoscopic ultrasonography,computed tomography(CT)or magnetic resonance imaging.Currently,transabdominal high-resolution ultrasound combined with gastrointestinal contrast agent can be used to diagnose stomach tumors effectively and without invasive procedures or radiation.However,although an appreciable number of cases of gastric schwannoma(GS)have been reported since the first description of such in 1988,the ongoing lack of a comprehensive list of ultrasonic characteristics has limited the accuracy of preoperative ultrasound diagnosis.CASE SUMMARY A 64-year-old female patient presented to our hospital with dizziness and head discomfort.During an abdominal ultrasound,a hypoechoic gastric mass was found,having clear and regular boundaries and no observable blood flow.Based on these characteristics,a gastrointestinal stromal tumor was suspected.Results from an endoscopic ultrasound biopsy and accompanying immunohistochemical analysis,coupled with abdominal CT findings indicating lymph node enlargement around the stomach,led to diagnosis of GS but did not exclude malignancy.After surgical resection of the tumor,the final diagnosis of GS without lymph node metastasis was made.No recurrence has occurred in the 6 years of follow-up.CONCLUSION A clearly defined ultrasonic characteristic profile of GS is important to improve diagnostic accuracy.

Relationship of preoperative gastric cancer CT enhancement ratio and perfusion parameters with serum tumor marker levels and proliferation molecule expression in tumor lesions

Objective:To study the relationship of preoperative gastric cancer CT enhancement ratio and perfusion parameters with serum tumor marker levels and proliferation molecule expression in tumor lesions.Methods:A total of 68 patients with gastric cancer treated in the Second Hospital of Yulin City between May 2012 and May 2016 were chosen as observation group and sub-divided into early and middle gastric cancer group (n=41) and advanced gastric cancer group (n=27) according to the tumor stage;50 patients diagnosed with benign gastric diseases in our hospital during the same period were selected as benign gastric lesion group. CT enhancement rate and perfusion parameters of three groups of patients were detected by CT scan, serum tumor marker levels were evacuated by enzyme-linked immunosorbent assay (ELISA), and the proliferation gene mRNA expression levels were detected by RT-PCR method.Results: CER, AF, BV and CL levels of advanced gastric cancer group were higher than those of early and middle gastric cancer group and benign gastric lesion group;serum CA72-4, CA19-9, CA125 and CEA contents of advanced gastric cancer group were higher than those of early and middle gastric cancer group and benign gastric lesion group;CADM1, miRNA-34a and Cystatin M mRNA expression in tissue of advanced gastric cancer group were lower than those of early and middle gastric cancer group and benign gastric lesion group while Survivin and I2PP2A mRNA expression were higher than those of early and middle gastric cancer group and benign gastric lesion group. The Pearson test showed that the CT enhancement rate and perfusion parameters in patients with gastric cancer are directly correlated with the serum tumor marker levels and the proliferation gene expression in tumor lesions.Conclusion: Preoperative gastric cancer CT enhancement rate and perfusion parameters are directly related to the tumor malignancy, and can be used as a reliable method for the long-term tumor diagnosis and malignancy judgment.

Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach

Inflammatory fibroid polyp(IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography(CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.

Value of Multi-slice spiral CT in diagnosis of malignant gastrointestinal stromal tumors

Objective： The aim of this study was to investigate the value of multi-slice spiral CT （MSCT） in the diagnosis of malignant gastrointestinal stromal tumors （GISTs）. Methods： Twenty-seven cases of MSCT images of malignant GIST proved by surgery and pathology were retrospectively analyzed. Both plain and enhanced CT scan was performed and multiplanar reconstruction was made in all cases. Results： The lesions originated from the stomach （n = 11）, small intestine （n = 9）, colon （n = 4）, rectum （n = 1）, and mesentery （n = 2）. The transverse diameters of mass were 4.2-22 cm, the edges clearly （n = 12）, unclearly （n = 15）. The mass were mainly irregular in shape Iobulated （n = 19）. The lesions were mainly heterogeneity on plain scan, moderate to marked enhancement in arterial phase and durative enhanced in venous phase. Cystic necrosis were observed in all the lesions, 9 cases were cystic and solid mixed mass. Hepatic metastases （n = 4）, pulmonary metastasis （n = 1）, lymphatic metastasis （n = 2） were detected. The accuracy rate of MSCT diagnosis for location and pathologic features of GISTs were 85.2% （23/27） and 77.8% （21/27）. Conclusion： Two-phase MSCT examination and axial images combined with multiplanar reconstruction images have important value for diagnosis of malignant GIST.

Primary gastric melanoma: A case report with imaging findings and 5-year follow-up

BACKGROUND Most melanomas identified in the stomach are metastatic;primary gastric melanoma(PGM)is extremely rare,and the relevant studies are relatively scarce.PGM may be incorrectly diagnosed as other gastric malignant tumor types.CASE SUMMARY We describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis.A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain.Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia.Computed tomography(CT)revealed a heterogeneous tumor with uneven enhancement.Enlarged lymph nodes were noted in the lesser curvature of the stomach.On magnetic resonance imaging(MRI),T1-and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor,respectively,both of which increased substantially after uneven enhancement.Near total gastrectomy was performed,and the tumor was pathologically confirmed to be a gastric melanoma.Because no other possible primary site of malignant melanoma was suspected,a clinical diagnosis of PGM was made.The patient was followed for nearly 5 years,during which she received CT reexamination,but no recurrence or metastasis was observed.CONCLUSION Certain imaging characteristics could be revealed in PGM.Imaging examination can be of great value in preoperative diagnosis,differential diagnosis,and followup of patients with PGM.

Enlarged accessory spleen presenting stomach submucosal tumor

A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity originated from extragastric organs. An abdominal contrast-enhanced computed tomography (CT) showed that the well-marginated ovoid mass, approximately 6 cm in diameter, enhanced homogenously to a similar degree as splenic parenchyma. 99mTechnetium sulfur colloid scintigraphy revealed the splenic nature of the mass. A diagnosis of accessory spleen mimicking gastric SMT was made. Subsequent follow-up was uneventful without performing splenectomy.

能谱CT在胃癌、胃间质瘤鉴别诊断中的临床价值

目的探讨能谱电子计算机断层扫描(CT)在胃癌(GC)、胃间质瘤(GIST)鉴别诊断中的临床价值。方法回顾性分析2021年1月至2023年5月新乡医学院第四临床学院收治的130例胃部常见肿瘤患者的临床资料,根据病理检查结果将其分为GC组(89例)和GIST组(41例),其中GC组根据分化程度分为低分化组(42例)和中、高分化组(47例)。所选患者均接受能谱CT检查,比较GC组和GIST组动脉期(AP)、静脉期(VP)下的碘浓度(IC)、水浓度(WC)、标准化碘含量(NIC)值,对比GC组和GIST组、低分化组和中、高分化组AP、VP 40~140 keV不同单能量下的CT值及能谱曲线斜率λ。结果GC组VP下的IC、NIC值均高于GIST组(P<0.05)。GC组AP、VP 40 keV、90 keV、140 keV下的CT值均高于GIST组(P<0.05);AP、VP 40~140 keV下的能谱曲线斜率λ均高于GIST组(P<0.05)。低分化组AP、VP 40 keV、90 keV、140 keV下的CT值均高于中、高分化组(P<0.05);AP、VP 40~140 keV下的能谱曲线斜率λ均高于中、高分化组(P<0.05)。结论GC和GIST能谱多参数定量有助于鉴别诊断GC和GIST。

39例胃间质瘤MSCT影像特征及其指导危险度分级的价值

目的观察39例胃间质瘤多层螺旋计算机断层扫描(MSCT)的影像特征,分析影像特征指导危险度分级的价值。方法收集2019年1月至2023年12月于我院确诊的39例胃间质瘤患者的临床资料进行回顾性分析。所有患者均行MSCT检查,观察MSCT影响特征并评估其危险度分级,并以此为标准将39例胃间质瘤患者分为极低危+低危组(n=12),中危组(n=15)和高危组(n=12)。多因素Logistic回归分析预测胃间质瘤危险度分级的独立影响因子。结果不同危险度分级胃间质瘤患者除消化道出血情况间有差异外(χ^(2)=6.608,P=0.037),其余基线资料比较,差异无统计学意义(P>0.05)。不同危险度分级胃间质瘤患者生长部位、动脉期强化程度、静脉期强化程度、延迟期强化程度比较,差异无统计学意义(P>0.05)。不同危险度分级胃间质瘤患者肿瘤最大径、钙化情况、坏死情况、肿瘤血管、形态、血管样强化、生长方式、边界光滑程度和强化方式间差异显著(P<0.05)。肿瘤最大径、形态、生长方式和强化方式是预测胃间质瘤危险度分级的独立影响因子(P<0.05)。结论胃间质瘤的MSCT具有独特的影像学特征,可重点关注肿瘤最大径、形态、生长方式和强化方式判断肿瘤的危险度,以更好指导临床方案决策。

多层螺旋CT对2~5 cm胃间质瘤危险度分级的评估价值

目的探讨多层螺旋CT对2~5cm胃间质瘤(GST)危险度分级的评估价值。方法选取165例经手术病理证实的2~5cm GST患者的临床、病理及影像学资料,根据病理结果分为肿瘤倾向良性生物学行为组(116例)和倾向恶性生物学行为组(49例),分析两组患者临床、CT特征的差异,运用多因素logistic回归分析及受试者工作特征曲线(ROC)分析独立影响因素对肿瘤危险度分级的诊断效能。结果GST的最大径、最小径、生长方式、形态、溃疡、囊变或坏死、肿瘤血管、肿瘤周围淋巴结、强化方式、强化程度等方面在危险度分级中差异均有统计学意义(P<0.05),其中肿瘤最大径、最小径、肿瘤血管与病理危险度分级呈中度正相关,肿瘤最大径的曲线下面积(AUC)最大,为0.894,特异度、准确度最高,分别为87.8%、87.3%。经Logistic回归分析,GST最大径线(OR=7.560,P<0.001)、生长方式(OR=2.747,P=0.002)、肿瘤血管(OR=5.817,P=0.001)为鉴别GST不同危险度分级的独立影响因素。将肿瘤最大径、生长方式、肿瘤血管联合,AUC为0.936,诊断效能均高于单一方法(Z=2.016~5.770,P=0.001~0.044);敏感度为83.3%,特异度为91.8%,准确度为89.6%,均高于单一方法。结论多层螺旋CT对2~5cm GST危险度的分级有重要诊断价值,联合肿瘤最大径、生长方式、肿瘤血管可以更好的评估肿瘤危险度分级,对患者术前评估及治疗方式的选择有重要意义。

螺旋CT薄层扫描对胃部良恶性肿瘤性质的鉴别诊断价值及影像学特征分析

目的:探讨螺旋电子计算机断层扫描(CT)薄层扫描对胃部良恶性肿瘤性质的鉴别诊断价值,为胃癌诊治提供科学参考。方法:回顾性分析2021年1月—2022年1月河南科技大学第一附属医院收治的106例胃部肿瘤患者的临床资料,所有患者均接受X线钡餐与CT薄层扫描检查,根据患者胃镜活检或手术病理检查结果,将65例良性肿瘤患者分为良性组,将41例恶性肿瘤患者分为恶性组。比较胃部良恶性肿瘤的影像学特征,主要包括肿块直径、病灶边缘状态、恶性龛影、黏膜侵犯、肌层侵犯等特征。以胃镜活检或手术病理检查为金标准,分析X线钡餐、CT、X线钡餐+CT诊断胃部良恶性肿瘤的效能。结果:恶性组肿块直径≥5 cm、病灶边缘欠清、恶性龛影、黏膜侵犯、肌层侵犯等影像学特征检出率高于良性组,差异有统计学意义(χ^(2)=13.974、15.851、19.755、15.306、7.949,P<0.05)。X线钡餐+CT薄层扫描诊断胃部良恶性肿瘤的符合率、灵敏度、特异度、阳性预测值、阴性预测值,均高于X线钡餐、CT薄层扫描单一诊断方式,差异有统计学意义(χ^(2)=20.673、13.529、8.159、10.332、11.248,P<0.05);X线钡餐诊断胃部良恶性肿瘤的AUC为0.685,CT薄层扫描诊断胃部良恶性肿瘤的AUC为0.762,X线钡餐+CT薄层扫描诊断胃部良恶性肿瘤的AUC为0.898。结论:CT薄层扫描能够为胃部肿瘤的良恶性诊断与病情评估提供科学参考依据,操作简单且敏感性好。

增强CT列线图预测模型在鉴别≤5 cm胃间质瘤与胃神经鞘瘤中的应用

目的评估增强CT列线图预测模型在鉴别诊断直径≤5 cm的胃间质瘤(GST)与胃神经鞘瘤(GS)中的应用价值。方法本研究回顾性分析了2018年1月至2023年6月间,在弋矶山医院由手术病理及免疫组化证实的84例GST患者和23例GS患者的临床资料及增强CT图像特征,共计纳入23个相关变量。通过单因素分析筛选出影响显著的变量(P<0.05),并将这些变量用于构建多因素预测模型,并绘制相应的列线图。模型的诊断效能通过受试者操作特征(ROC)曲线及其曲线下面积(AUC)进行评估,并通过DeLong检验比较不同变量和列线图的诊断效能。模型的准确性通过校正曲线进行内部验证,并通过2折交叉验证进一步验证。结果单因素分析确定8个显著变量:肿瘤形态、生长部位、生长方式、静脉期不均匀率(SHRTv)、静脉期强化率(ERTv)、延迟期强化率(ERTd)、静脉期增强程度(DEv)和延迟期增强程度(DEd),其中肿瘤形态、生长部位和DEd为鉴别诊断的独立影响因素。列线图区分GST与GS的AUC为0.894(95%CI:0.818~0.969),灵敏度为79.8%,特异度为91.3%。校正曲线表明模型预测与实际观测结果具有良好一致性。结论基于增强CT特征的列线图预测模型在鉴别直径≤5 cm的GST与GS中显示出高效能,通过内部验证和交叉验证证实了其可靠性。

胃神经鞘瘤与胃间质瘤多排CT特征及误诊分析

目的探讨10cm以下的胃神经鞘瘤与胃间质瘤的多排CT特征,分析其误诊原因。方法回顾性分析本院近3年经手术病理证实的6例胃神经鞘瘤和15例胃间质瘤的完整临床、影像学资料,分析二者的多排CT特征。结果6例胃神经鞘瘤,5例误诊为胃间质瘤,6例神经鞘瘤和15例胃间质瘤均为单发肿块,均位于胃体部,前者形态规则呈类圆形,密度均匀,边界清晰,周围脂肪间隙无浸润。后者密度不均,形态不规则呈分叶状,部分病灶周围脂肪间隙欠清晰。二者均以向腔内生长为多。动态增强前者呈中度均匀渐进性强化,后者为动脉期强化,门静脉期强化最明显,平衡期减退,病灶内低密度区不强化或轻度强化。前者周围可见小淋巴结影,后者可见肿大淋巴结影,二者均未见远处转移。结论10cm以下胃神经鞘瘤与胃间质瘤在形态、边界、囊变、密度,强化方式,周围脂肪间隙及淋巴结情况有一定的特征,具有鉴别诊断意义,但肿瘤较小时,影像学鉴别较难。

计算机断层扫描与超声内镜对胃上皮下肿瘤诊断能力的比较研究

目的比较计算机断层扫描(CT)与超声内镜(EUS)对胃上皮下肿瘤诊断的准确性。方法回顾性分析97例经普通白光内镜诊断胃上皮下肿瘤的患者,进行EUS和CT扫描,比较CT与EUS对胃上皮下肿瘤的诊断能力。使用受试者工作特征(ROC)曲线来计算CT可见肿瘤的最佳截点直径。真性胃上皮下肿瘤的患者接受内镜或外科手术治疗,通过与术后病理结果的对比,评价CT对真性胃上皮下肿瘤性质的诊断价值。结果在97例胃上皮下肿瘤同时行CT和EUS检查的患者中,EUS共检出73例真性胃上皮下肿瘤,24例外压隆起。73例真性胃上皮下肿瘤患者中,CT检出肿瘤32例,CT未检出41例,CT诊断的灵敏度为43.83%,特异度为100%。对CT可检出的肿瘤直径进行ROC曲线分析,认为直径大于9.85 mm的肿瘤CT更容易识别。CT和EUS对真性胃上皮下肿瘤诊断的准确率分别为46.88%及64.38%,差异无统计学意义(P>0.05)。结论CT扫描可推荐作为直径大于9.85 mm的胃上皮下肿瘤的辅助诊断、随访的方法之一。对于大于9.85 mm的胃上皮下肿瘤,CT增强扫描与EUS定性诊断的价值相似。

螺旋CT对胃间质瘤的诊断及危险度分级的评估价值

目的探讨螺旋CT对胃间质瘤的诊断及危险度的评估价值。方法回顾性分析54例经手术病理证实的胃间质瘤患者的临床、影像及病理资料,并将CT特征与其危险度的分级进行对照研究。结果在54病例中,高危险度16例,中危险度11例,低危险度27例。胃间质瘤的液化坏死、瘤内气体、迂曲血管、最大径及LD/SD值在不同危险度患者中差异有统计学意义(P均<0.05),而形状、生长方式及瘤内的钙化灶在不同危险度患者中差异无统计学意义(P均>0.05)。静脉期及延迟期腹主动脉、肝门静脉及下腔静脉的CT值与相应时期肿瘤实质CT差值的比值在各危险度患者中差异有统计学意义(P均<0.05)。结论 CT扫描能清楚显示胃间质瘤发生部位、肿块大小、形态、密度、生长方式、钙化、液化坏死、瘤内气体及迂曲血管等征象,CT对胃间质瘤危险度的分级具有重要的参考价值。

超声双重造影和增强CT在胃间质瘤诊断中的应用

目的：通过与术后病理对照及相互间比较，对比分析超声双重造影（ DCUS）和增强CT在胃间质瘤诊断中的价值。方法回顾性分析2007年7月～2014年12月在温州医科大学附属第二医院均接受DCUS和增强CT检查的40例胃间质瘤患者临床资料。所有病灶均经手术病理证实。对比DCUS与增强CT对胃间质瘤病灶的检出率，对比对胃间质瘤定位诊断和定性诊断的正确率。结果40例胃间质瘤中病理诊断为低危24例，高危16例。 DCUS对胃间质瘤病灶的检出率为98％（39／40），增强CT对胃间质瘤病灶检出率93％（37／40），两者比较差异无统计学意义（ P ＝0．615）。DCUS定位诊断正确率为97％（38／39），增强CT定位诊断正确率为70％（26／37），两者比较差异有统计学意义（ P ＝0.001）。 DCUS定性诊断正确率为87％（34／39），增强CT定性诊断正确率为89％（33／37），两者比较差异无统计学意义（ P ＝1．00）。结论 DCUS在胃间质瘤病灶的定位能力上明显优于增强CT，但在胃间质瘤的检出能力上和在胃间质瘤生物学行为的诊断能力上与增强CT相近，因此可作为增强CT的重要补充甚至替代方法。

螺旋CT诊断胃间质瘤

目的探讨螺旋CT对胃间质瘤的诊断价值。方法回顾性分析经手术病理证实的20例胃间质瘤患者的临床和CT检查资料。结果CT平扫均呈单发软组织肿块,其中9例为恶性,肿块较大,最大径均>5.0cm,密度不均匀,部分有囊变坏死;11例为潜在恶性,瘤体相对较小,最大径均<5.0cm,多数密度均匀。2例病变出现钙化。CT增强后肿瘤实质部分均有较明显强化。多平面重建可清晰显示肿瘤与胃的关系。结论胃间质瘤的CT表现有一定的特征性,CT扫描+多平面重建有助于定位和定性诊断。

胃间质瘤:螺旋CT表现与手术病理对照

目的:分析胃间质瘤的螺旋CT表现,评价螺旋CT鉴别胃间质瘤良恶性价值。方法:对29例胃间质瘤患者行螺旋CT扫描,对肿瘤的部位、大小、形态、增强特点、肿瘤与邻近器官的关系及有无转移进行回顾性分析,结果与手术病理对照。结果:良性6例,交界性5例,恶性18例。CT表现:肿物多具有壁在性、外生性特点(23例),腔内型6例。除5例良性肿物密度均匀外,其余均表现密度不均匀。6例高度恶性肿物表现边缘强化,中心大片低密度。病理所见:肿瘤实性部分为由梭形细胞和(或)上皮样细胞组成,变性、出血、囊变及坏死在CT均表现为低密度。肿物内伴斑点样钙化1例。胰腺、脾受侵各1例,胃壁受侵7例。多平面重建图像(MPR)排除横断面诊断胰岛细胞瘤和肝癌各1例。合并肝转移2例,淋巴结转移1例。结论:胃间质瘤的CT表现与其病理组织学相关。螺旋CT特别是MPR图像,在肿瘤的检出、判断肿瘤与周围器官的关系及有无转移上发挥重要作用,在判断肿瘤的良恶性上仍有困难。