胃肠道间质瘤的CT诊断及误诊分析  

CT findings of gastrointestinal stromal tumor:a report of 16 cases

作　　者：陈朔[1] 许乙凯[1] 贾飞鸽[1] 

机构地区：[1]南方医科大学附属南方医院影像中心,广东广州510515

出　　处：《医学影像学杂志》2010年第2期274-277,共4页Journal of Medical Imaging

摘　　要：目的：探讨胃肠道间质瘤（GIST）的CT征象。方法：对照病理表现回顾性分析16例GIST的CT表现。结果：CT表现为腔外生长（70%）或腔内生长（30%）的圆形、类圆形或分叶状肿块;边界光滑（85%）,稍毛糙（15%）;密度均匀（20%）或中心可见低密度（80%）（低密度区占整个肿块的25%-90%,平均58%）,2例肿块局部与肠腔相通而分别见气体和气液平;增强扫描实质部分动脉期轻中度强化（CT值增加8-28HU,平均增加16HU）,静脉期进一步强化并趋于均匀（CT值进一步增加5-15HU,平均增加9HU）,2例肿块内动脉期可见强化血管影。GIST中央坏死与肠腔相通形成假肠腔时,观察是否与肠腔直接相通、有无肿大淋巴结有助于与胃肠道淋巴瘤鉴别;与子宫或附件关系密切时,观察边界与比邻、强化程度、肿瘤标记物有助于与子宫肌瘤或卵巢癌鉴别;与腹腔胸膜外恶性孤立性纤维性肿瘤鉴别困难。结论：GIST有一些特点。对于CT征象较典型的GIST,有些CT征象可帮助鉴别诊断。Objective：To investigate CT findings of gastrointestinal stromal tumor（GIST）.Methods：CT findings in 16 patients with histologically confirmed GIST were retrospectively analyzed and correlated with pathological findings.Results：On spiral CT,GIST showed the soft tissue lumps with round or sublobe shape,outpocketing from medial wall（70%） or lateral wall（30%） of gastrointestinal tract,with clear margins（85%） or without（15%）.Non-enhanced low density was found in 80% masses,occupying the entire masses of 25% to 90%,with an average of 58%,but 20% masses showed homogeneous density.Gas and liquid level were found respectively in two masses because of communication between intra-tumorous necrosis and lumen.On contrast enhanced spiral CT,the solid part of masses showed mild or moderate enhancement in the arterial phase and futher enhancement into more homogeneous in the venous phase.Enhanced blood vessels can be found in the arterial phase in two masses.When false lumen apeared because of communication between intra-tumorous necrosis and lumen,observing whether masses communicated directly with lumen or not and enlarged lymph nodes would help with the identification of gastrointestinal lymphoma.When masses closely attached with uterus or uterine adnexa,observing their boundary and adjacent,enhancement degree and tumor markers would help with the identification of uterine fibroids or ovarian cancer.It was difficult to distinguish between GIST and the abdominal extrapleural malignant solitary fibrous tumor.Conclusion：There are some features for GIST.Some CT signs might be helpful in the differential diagnosis for atypical GIST.

关 键 词：胃肠道间质瘤 体层摄影术 X线计算机 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]