胃神经鞘瘤与胃间质瘤的MSCT增强多参数鉴别诊断  

MSCT features of gastric schwannomas and gastrointestinal stromal tumors

作　　者：马丽娅 李震[1] 沈亚琪 胡道予[1] MA Li-ya;LI Zhen;SHEN Ya-qi;HU Dao-yu(Department of Radiology,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,湖北武汉430030

出　　处：《影像诊断与介入放射学》2018年第4期272-277,共6页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金(81571642;81701657;81771801);中央高校基本科研业务费专项资金资助(NO.2017KFYXJJ126)

摘　　要：目的对照病理回顾性分析胃神经鞘瘤与胃间质瘤,研究两者病灶增强CT特征及鉴别要点。方法记录并分析14例胃神经鞘瘤(GS)及69例胃间质瘤(GIST)的临床资料、大小、部位、生长方式、强化程度、强化是否均匀、溃疡、坏死、钙化及气体、动脉期及静脉期CT值、动脉期与静脉期CT值差值及差值百分比,并将胃GIST病灶根据病理进行危险程度分级,再与GS组病灶进行比较。结果 GS组患者平均年龄更小(GS组50.5±7.2岁,GIST组57.4±10.0岁,P=0.017),其余两组间临床资料无明显统计学差异(P>0.05)。GIST病灶强化更明显(GS组及GIST组强化程度为弱、中等、明显的病灶分别为8、6、0例和30、16、23例,P=0.005)且更不均匀(GS组及GIST组强化不均匀病灶分别为6、53例,P=0.026),余增强CT征象、动脉期及静脉期CT值、动脉期与静脉期CT值差值及差值百分比在两组间均无明显统计学差异。GIST病灶危险程度分级后,各组间临床资料无明显统计学差异。与GS病灶相比,高危GIST病灶明显强化多见(P=0.003),在极低危、低危GIST病灶强化也稍明显(P=0.044和0.045),均有统计学差异。与GS病灶相比,坏死在高危GIST病灶中较常见(P=0.047),极低危GIST病灶大小明显较小(P<0.001),双期CT值差值及差值百分比较小(P=0.024)。结论与GS患者相比,GIST患者发病年平均龄稍大。相对于GS病灶,GIST中-高危病灶强化程度较高、强化更不均匀,高危病灶坏死征象更多,而极低危GIST病灶较小、双期CT值差值稍低,对于区分两者有一定鉴别意义。Objective To analyze the differentiating features of contrast-enhanced CT in gastric schwannoma （GS） and gastrointestinal stromal tumor （GIST）. Methods Contrast-enhanced CT of 83 patients with histologically confirmed GS （14） and GIST （69） were retrospectively analyzed. The clinical data, size, growth pattern, degree and homogeneity of contrast enhancement, ulcer, necrosis, density of calcification and gas, CT values in arterial and venous phases, and the difference between the two phases were analyzed. The GIST lesions were graded according to the risk and compared to GS lesions. Results The patients with GS （50.5±7.2） years were significantly （P=0.017） younger than that with GIST （57.4±10.0） years without significant （P〉0＊05） difference in other clinical data. Contrast enhancement was mild （8, 30）, moderate （6, 16）, marked （0, 23） in GS and GIST, respectively with statistical significance （P=0.005）. Enhancement uniformity was significantly （P=0.026） higher in GIST （53） than that in GS （6）. There was no significant difference among other signs, CT values, arterial and venous phases. The symptoms among patients with five grades of GST were not signiiicantly different. Enhancement of high-risk GIST （F=0.003）, very low-risk GIST （P=0.044）, and low- risk GIST （P=0.045） was significantly higher than that of GS. Compared to GS, low- to high-risk GIST had significantly more necrosis （P=0.047）; the very low-risk GIST were significantly smaller （P〈 0.001）; the difference between arterial and venous phases was significantly less （P=0.024）. Conclusion The patients with GIST are older and more likely to have hematemesis and necrosis on CT than those with GS. The contrast enhancement of intermediate-high risk GIST is greater and more heterogeneous, while very low- risk GIST is smaller, less likely to have necrosis, and less difference between arterial and venous phases.

关 键 词：胃神经鞘瘤 胃间质瘤 体层摄影术 X线计算机 危险程度分级 

分 类 号：R730.44[医药卫生—肿瘤] R735.2[医药卫生—临床医学]