胃神经鞘瘤MSCT表现及误诊原因分析  

MSCT features of gastric schwannoma and misdiagnosis analysis

作　　者：侯刚强 高德宏 沈比先 曾志斌 熊伟[2] 

机构地区：[1]广东医科大学附属深圳第六医院放射科,广东深圳510515 [2]南方医科大学南方医院影像中心,广东广州518052

出　　处：《实用放射学杂志》2017年第12期1874-1876,1909,共4页Journal of Practical Radiology

摘　　要：目的 探讨胃神经鞘瘤MSCT征象、诊断价值及误诊原因。方法 回顾分析经手术病理证实的9例胃神经鞘瘤CT图像、病理及临床资料。观察病灶位置、大小、轮廓、边界、生长方式、增强模式、出血、坏死、钙化及胃周淋巴结等指标。结果 本组病例均表现为单发、边界清楚的圆形或类圆形肿块，其中6例位于胃体（胃大弯4例，胃小弯2例），2 例位于胃窦，1 例位于胃底。病灶最大径约2.5～7.4 cm，平均3.2 cm。2例腔外生长，2例腔内生长，5例腔内、外生长。平扫病灶表现为均匀低密度，均未见囊变、坏死区及钙化灶。2例可见溃疡面形成。2例胃周可见肿大淋巴结，病理证实为反应性增生。增强扫描动脉期4例病灶轻度均匀强化，5例未见明显强化；静脉期均呈中度均匀强化。其中4例延迟期进一步强化。结论胃神经鞘瘤MSCT常表现为边界清楚、密度略低的软组织肿块，无出血坏死和囊变灶。MSCT检查有助于胃神经鞘瘤的定位、定性以及观察肿瘤与周围组织结构的关系。Objective To explore the MSCT features,diagnostic values and the misdiagnosis causes of gastric schwannomas.Methods The CT images, pathological and clinical data of 9 misdiagnosis cases of gastric schwannomas were analyzed retrospectively, which were later confirmed by the operation and pathology. The study examined the CT findings in the following aspects： the lesion location, size, contour, border, growth pattern, enhanced pattern, hemorrhage, necrosis, calcification, and the presence and absence of perirenal lymph nodes. Results The gastric schwannomas were ovoid or round, with well-defined boundaries. Tumors were found in the gastric body in 6 cases （4 cases in the large gastric curvature and 2 in the small gastric curvature} ,the gastric antrum in 2 cases and the gastric fundus in 1 case. The largest lesion diameters ranged from 2.5 to 7.4 cm, with an average diameter of 3.2 cm. Extracavitary growth was found in 2 cases, intracavitary growth in 2 cases and both intracavitary and extracavitary growth in 5 cases. The density of the tumor was low and evenly distributed, without cystic change, necrosis or calcification. 2 cases were found to have ulcer formation. Another 2 cases were found to have enlarged lymph nodes, which were pathologically confirmed to be reactive hyperplasia. In the CT contrast enhancement, mild homogeneous enhancement was found in 4 cases in the arterial phase, but no obvious enhancement was found in the other 5 cases. In the venous phase, all the cases were found to have moderate homogeneous enhancement. 4 cases were found to have further enhancement in the delay phase.Conclusion The gastric schwannomas appears to be homogeneous soft tissue mass on the MSCT, with clear boundaries and low-density and without hemorrhagic necrosis or cystic lesions.MSCT examination can help to locate and characterize gastric schwannomas, and to observe the relationship between the tumor and the surrounding tissue structure.

关 键 词：胃肿瘤 神经鞘瘤 误诊 计算机体层成像 

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