胃间质瘤与原发性胃淋巴瘤的CT征象及鉴别诊断  

Gastric Stromal Tumor and Primary Gastric Lymphoma: CT Imaging and Differential Diagnosis

作　　者：刘涛[1] 杨存保[1] 李景雷[2] 

机构地区：[1]深圳市龙岗区人民医院影像科,广东深圳518172 [2]广东省人民医院放射科广东省医学科学院,广东广州510080

出　　处：《中国医学影像学杂志》2013年第11期849-852,共4页Chinese Journal of Medical Imaging

摘　　要：目的探讨胃间质瘤(GST)与原发性胃淋巴瘤(PGL)的CT表现及鉴别诊断。资料与方法纳入经病理证实的26例GST患者和21例PGL患者,观察CT图像所示病变部位、数目、范围、与邻近胃壁的关系、密度、强化特征、黏膜及浆膜情况、胃周淋巴结及其他器官侵犯。结果 26例GST患者均为单发局限性肿块,位于胃底17例,胃体部9例,与邻近胃壁界限清;21例PGL患者均有不同程度的弥漫胃壁增厚,与邻近胃壁界限不清或相延续。CT平扫示GST为均匀等或稍低密度,或不均匀等低混杂密度,实性部分平均CT值为(32±11)Hu;PGL呈均匀等密度,平均CT值为(52±9)Hu,两者差异有统计学意义(t=12.37,P<0.05)。增强扫描示GST呈均匀、不均匀明显延迟强化,而PGL呈轻度均匀延迟强化,门静脉期GST与PGL强化程度差异有统计学意义(t=5.35,P<0.05)。26例GST患者病变处浆膜层光滑清晰,无一例见胃周淋巴结肿大;PGL病变处浆膜层模糊2例,19例浆膜层光滑清晰;6例PGL见胃周淋巴结肿大。结论 GST病变局限、CT呈不均匀低密度并不均匀明显强化;PGL病变相对弥漫、CT呈均匀等密度并轻度均匀强化,有助于两者的诊断及鉴别诊断。Purpose To explore the CT findings of gastric stromal tumor （GST） and primary gastric lymphoma （PGL） tbr differential diagnosis. Materials and Methods The CT findings of 26 patients with GST confirmed pathologically and 21 patients with PGL confirnled pathologically were retrospectively analyzed with regards to location of lesion, number, range, relation between lesion and gastric wall, density, enhancement pattern, change of gastric mucoma and serous layer, and encroachment of perigastric lymph nodes and other organs. Results CT scans demonstrated that all 26 GST cases had single localized mass with relatively well-defined margin （17 cases located in gastric fundus, 9 cases inside stomach body） and that all 21 PGL cases showed single irregular dilthsed thickening of gastric waN, and most of which located in 2 or 3 parts with ill-defined margin. On plain CT scan, all lesions of GST appeared slightly hypo-density or iso- density, or heterogeneous density [mean CT value （32 ± 11 ） Hu]; while all lesions of PGL presented homogeneous iso-density [mean CT value （52 ±9） Hu] with statistical difference （t=12.37, P〈0.05）. On contrast enhanced scan, GST showed obvious homogeneous or heterogeneous delayed enhancement whereas PGL displayed slightly homogeneous delayed enhancement with statistical difference （t=5.35, P〈0.05）. Smooth and clear gastric mucosa was found in 26 GST cases without any perigastric lymph node enlargement. Two PGL cases had obscure gastric mucosa and the other 19 PGL cases showed smooth and clear gastric mucosa, 6 PGL cases with lymph node enlargement. Conclusion On CT scan, lesions of GST are limited, with heterogeneous density and obviously heterogeneous enhancement; whilst PGL has diffuse lesions, associated with homogenous density and slightly homogeneous enhancement. The different features are helpful in the diagnosis for both diseases.

关 键 词：胃肠道间质肿瘤 胃肿瘤 淋巴瘤 体层摄影术 螺旋计算机 诊断 鉴别 

分 类 号：R735.2[医药卫生—肿瘤] R445.3[医药卫生—临床医学]