多层螺旋CT在胃淋巴瘤及胃神经内分泌肿瘤中的鉴别诊断价值  

Value of multislice spiral CT scanning in differential diagnosis of gastric neuroendocrine tumor and primary gastric lymphoma

作　　者：吴胜男 霍鲁月 庄帅帅 孙为豪[2] WU Shengnan;HUO Luyue;ZHUANG Shuaishuai;SUN Weihao(Department of Geriatric Medicine,the First Affiliated Hospital of Wanan Medical College,Wuhu Anhui 241000,China;Department of Geriatric Gastroenterology,First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210029,China)

机构地区：[1]皖南医学院弋矶山医院老年医学科,安徽芜湖241000 [2]南京医科大学第一附属医院老年消化科,江苏南京210029

出　　处：《转化医学杂志》2022年第6期347-350,共4页Translational Medicine Journal

基　　金：国家自然科学基金资助项目(81072030)。

摘　　要：目的 比较原发性胃淋巴瘤(primary gastric lymphoma,PGL)和胃神经内分泌肿瘤(gastric neuroendocrine tumor,G-NET)的CT征象,为临床诊断及鉴别诊断提供影像学依据。方法 纳入经病理证实的38例PGL患者和23例G-NET患者,对比两者的临床资料及CT特征,包括病变大小、部位、数目、形态、CT强化特征、黏膜及浆膜完整性,胃周淋巴结及其他器官侵犯情况。结果 G-NET患者多表现为胃多发性隆起样病变,数目多发、散发,集中于胃体部,与临近胃壁界限清,未见明显浆膜受累,肿瘤形态以圆形或半圆形隆起最多见,CT增强扫描呈轻中度不均匀强化。PGL患者均有不同程度的弥漫胃壁增厚,溃疡形态多见,病变部位主要包括胃窦胃体,与邻近胃壁界限不清或相延续。CT增强扫描呈轻度均匀延迟强化。通过对两组患者的CT表现分析,两组患者在年龄(P=0.024)、肿瘤大小(P<0.001)、数目(P<0.001)、强化方式(P<0.001)均有统计学意义。随后对以上特征进行多因素分析,肿瘤大小(OR=4.757,P=0.005)、数目(OR=0.087,P=0.045)可作为G-NET和PGL的独立鉴别因子。结论 多层螺旋CT对于G-NET和PGL的鉴别诊断有一定的临床价值。Objective To explore the power of CT signs in differential diagnosis of PGL and G-NET. Methods Sixty-one patients including 38 PGL and 23 G-NET confirmed by pathology were enrolled. Clinical and CT features including tumor size, tumor number, tumor location, tumor morphology, CT characteristics, mucous membrane and serous membrane integrity, lymph nodes, and organs metastasized were compared between the two groups. Results G-NET patients mostly presented with multiple uplift-like lesions in the stomach, which were numerous and sporadic, concentrated in the body of the stomach, with a clear boundary with the adjacent gastric wall, and no obvious serosal involvement was observed. The tumor morphology was mostly circular or semicircular uplifts, and CT enhanced scan showed mild to moderate uneven enhancement. PGL patients had varying degrees of diffuse gastric wall thickening and ulcer morphology was common. The lesion sites mainly included gastric antrum and gastric body, with unclear boundary or continuous phase with adjacent gastric wall. CT enhanced scan showed mild uniform delayed enhancement. CT findings of the two groups showed statistically significant differences in age(P=0.024), tumor size(P<0.001), number(P<0.001) and enhancement method(P<0.001). Multivariate analysis of the above characteristics showed that tumor size(OR= 4.757, P=0.005) and number(OR=0.087, P=0.045) could be used as independent differentiators of G-NET and PGL. Conclusion CT scan is of certain clinical value for differential diagnosis between G-NET and PGL.

关 键 词：胃淋巴瘤 胃神经内分泌肿瘤 螺旋CT 鉴别诊断 

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