64排螺旋CT动态增强扫描结合后处理对胃肠道外间质瘤的诊断价值  

Value of 64-slice spiral CT in the diagnosis of extragastrointestinal stromal tumor with three-dimensional reconstruction

作　　者：邓雪英[1] 陈小启[1] 王付言[1] 李清海[2] 宋春瑶[1] 丁建平[1] 

机构地区：[1]杭州师范大学附属医院放射科,浙江杭州310015 [2]浙江大学附属第二人民医院放射科,浙江杭州310025

出　　处：《外科理论与实践》2014年第3期251-255,共5页Journal of Surgery Concepts & Practice

摘　　要：目的：探讨64排螺旋CT动态增强扫描结合后处理对胃肠道外间质瘤（extragastrointestinal stromal tumor，EGIST）的诊断价值。方法：回顾性分析8例经手术病理证实的EGIST CT表现及临床资料。所有病例均行64排螺旋CT动态增强扫描，包括平扫、动脉期、门静脉期和延迟期，扫描结束后在GE ADW4．4工作站行多平面重组（multiple planar reconstruction，MPR），观察肿块的大小、形态、边缘和强化程度，肿块周围和（或）内部有无血管影．肿块与邻近脏器的关系，分析肿块的来源与性质。结果：8例EGIST中，位于腹膜后3例，肠系膜3例，小网膜1例，肝脏1例。肿瘤最大径平均（11．0±2.4）（7．7～15．0）cm，圆形或卵圆形4例，分叶状3例，不规则形1例。平扫肿块内密度不均。见斑片状、瘢痕状及大片状坏死囊变区，囊变坏死部分CT值为25。28HU，实性部分CT值为34-47HU，增强后动脉期实性部分轻、中度强化3例。CT值较平扫增加15～22HU：实性部分明显不均匀强化5例，CT值较平扫增加40-55HU。门静脉期渐进性强化6例．CT值较动脉期增加10-25HU。坏死区未见强化。增强后肿瘤周围和（或）内部可见线状扭曲血管影6例。结论：EGIST的影像学表现有一定特征性，多排螺旋CT动态增强结合MPR对于EGIST的定位与定性诊断有重要临床意义．建议为术前常规。Objective To investigate the value of 64-slice spiral CT dynamic enhancement with image postproeessing in extragastrointestinal stromal tumor（EGIST）. Methods Eight patients with EGIST examined by pathology were analyzed retrospectively basing on CT enhanced scan findings and clinical manifestation. All the patients were scanned using 64- row spiral CT. The scanning protocol consisted of plain scan, arterial phase, portal vein phase and delayed phase. The GE ADW4.4 workstation was used for multiple planar reconstruction （MPR）. Tumor size, shape, outline, enhancement pattern, the vessels around or/and in the mass, and relations to surrounding tissues were analyzed. Results Three of 8 cases located in retroperitoneum, 3 in mesentery, 1 in lesser omentum and 1 in liver respectively. The maximum diameter of tumors were （11.0±2.4） （7.7-15.0） cm. Four cases showed round or oval appearance, 3 lobulated and 1 irregular. On CT images without contrast, tumors demonstrated as heterogeneous, indicating necrosis. The CT value of necrotic and cystic portion was about 25-28 HU, and that of solid portion 34-47 HU. In arterial phase, 3 cases exhibited mild-to-moderate enhancement with CT value of 15-22 HU more. The remaining 5 cases showed apparent uneven enhancement with CT value of 40-55 HU more. Moreover, 6 cases manifested gradual enhancement in portal vein phase with CT value of 10-25 HU more. No enhancement was found in necrotic areas. The twisted and small vessels in tumor were found in 6 cases. Conclusions EGIST had some imaging characteristics. Multi-defector CT dynamic enhancement scanning combines with MPR has crucial clinical value for localization and qualitative diagnosis of EGIST.

关 键 词：胃肠道外间质瘤 X线计算机体层摄影术 多平面重建 

分 类 号：R735[医药卫生—肿瘤]