49例胃肠间质瘤多排螺旋CT表现与病理对照研究  

Correlation of multi-slice spiral CT features to clinicopathologic manifestations of gastrointestinal stromal tumor:a report of 49 cases

作　　者：尹韶晗[1,2] 谢传淼[1,2] 莫运仙[1,2] 黄子林[1,2] 吕衍春[1,2] 刘学文[1,2] 张赟[1,2] 李建鹏[1,2] 郑列[1,2] 吴沛宏[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心影像介入科,广东广州510060

出　　处：《癌症》2009年第9期983-988,M0002,共7页Chinese Journal of Cancer

摘　　要：背景与目的:胃肠间质瘤(gastrointestinal stromal tumor,GIST)是消化系统最常见的间叶源性肿瘤,影像学检查在其术前诊断及术后疗效评价中起着重要作用。本研究旨在分析胃肠间质瘤的螺旋CT表现和病理特点,以及它们之间的关系。方法:回顾性分析49例共53个经病理证实的胃肠道间质瘤的螺旋CT表现和病理学资料,将CT表现(包括大小、形态、生长方式、密度及强化方式)与生物学危险性进行对比研究。结果:53个GIST病灶的生物学危险性:极低度14个,低度11个,中度10个,高度18个。CT检查发现36个病灶(67.9%)。最大径≥50mm者,CT表现为形态不规则,呈浸润性生长,可见囊变坏死,明显不均匀强化,多为高度危险性;最大径<50mm者,大多形态规则,密度均匀,呈膨胀性生长,中度均匀强化,多为中度及以下危险性。发现血道转移5例,未见淋巴结转移。免疫组化结果仅有3个病灶S100阳性,CT均表现为沿胃壁或肠壁环形浸润。结论:CT检查有助于判断胃肠间质瘤的危险性,但对于微小病灶的检出有一定困难。神经方向分化(S100阳性)的间质瘤呈浸润性生长,其CT表现较难与胃癌鉴别。Background and Objective： Gastrointestinal stromal tumor （GIST） is one of the most common mesenchyrnal tumors of the digestive system. Imaging examination plays an important role in preoperative diagnosis and postoperative evaluation for it. This study was to describe the multi-slice spiral computed tomographic （MSCT） findings and pathologic features of GIST, and to analyze their correlation. Methods： MSCT and pathologic reports of 49 patients with 53 pathologically confirmed GIST lesions were reviewed and compared. Results; Of the 53 GIST lesions, 14 were at very low biological risk, 11 at low risk, ten at moderate risk and 18 at high risk; 36 （67.9%） were found in first visit by CT scans. On CT images, the GIST lesions with maximal diameter of ≥50 mm showed irregular shape, invasive growth, presence of cystic area and heterogeneous enhancement, and most of them were at high risk; the lesions with maximal diameter of 〈50 mm showed regular shape, expansive growth, and homogeneous enhancement, and most of them were at risk of moderate or below. No lymph node metastasis was found. Only three lesions showed S100-positive, which presented infiltration along the gastric wall or bowel ring on CT images. Conclusions： CT examination is helpful in risk prediction for GIST, but it is difficult to detect small lesions （〈 2 cm） by CT scans. Due to the infiltrative growth of GIST with neural differentiation （S100-positive）, it is difficult to distinguish GIST from gastric cancer on CT images.

关 键 词：间叶源性肿瘤 胃肠间质瘤 X线计算机 体层摄影技术 危险性 免疫组化 

分 类 号：R735[医药卫生—肿瘤]