小于4 cm胃神经鞘瘤CT误诊与漏诊分析  

Gastric schwannomas less than 4 cm:analysis of CT misdiagnosis and missed diagnosis

作　　者：吴辉行 张婉丽 吴嘉良 陈婧 黄丹萍[2] 杨蕊梦[2] WU Huixing;ZHANG Wanli;WU Jialiang;CHEN Jing;HUANG Danping;YANG Ruimeng(Department of Radiology,Guangzhou Geriatric Hospital,Guangzhou 510545,China;Department of Radiology,Guangzhou First People’s Hospital,Guangzhou 510180,China;Department of Radiology,Shenzhen Hospital,University of Hongkong,Shenzhen 518000,China;Department of Radiology,Yichang Central People’s Hospital,Yichang 443000,China)

机构地区：[1]广州市老年医院放射科,广东广州510545 [2]广州市第一人民医院放射科,广东广州510180 [3]香港大学深圳医院放射科,深圳518000 [4]宜昌市中心人民医院放射科,湖北宜昌443000

出　　处：《广州医药》2023年第9期46-51,57,共7页Guangzhou Medical Journal

摘　　要：目的探讨小于4 cm的胃神经鞘瘤(GS)的CT误诊与漏诊原因,从而加深影像科医师对GS的认识,提高其CT检出率及诊断准确率。方法回顾性分析2019年3月-2022年10月经手术切除及病理证实的10例小于4 cm的GS患者的临床、CT及病理资料。在CT图像上评估肿瘤的位置、大小、形态、密度、强化特点及周围淋巴结等情况。结果术前CT误诊7例,漏诊2例,仅1例正确诊断;10例病灶均起源于胃黏膜下;9例为圆形或类圆形;7例发生于胃体;平扫密度均低于肌肉组织,均呈渐进性强化。结论小于4 cm的GS术前误诊率很高,且可发生漏诊。当CT检查提示胃体部黏膜下圆形或类圆形占位病变,平扫呈均匀稍低密度,增强呈渐进性强化时应考虑GS的可能,最终确诊需病理及免疫组化检查。Objective To investigate the causes of CT misdiagnosis and missed diagnosis of gastric schwannomas(GS)smaller than 4 cm in size,and to improve radiologists’awareness of GS and increase the detection rate and diagnostic accuracy.Methods Clinical,pathological and CT data of ten surgically and pathologically confirmed GS patients were retrospectively reviewed between March 2019 and October 2022.The location,size,shape,attenuation,enhancement features and surrounding lymph nodes of each tumor on CT were analyzed.Results Of the 10 patients,7 cases were misdiagnosed in preoperative CT examination,two cases were missed diagnosed and only one case was correctly diagnosed.All tumors originated from the submucosa in ten cases,and nine cases showed a round or oval shape.Seven lesions were located in the gastric body,and all tumors had homogeneous low attenuation compared to muscle on plain CT images.All cases displayed mild-moderate to obvious enhancement.Conclusions GS smaller than 4 cm have a high rate of misdiagnosis and missed diagnosis preoperatively.When CT examination indicates a submucosa tumor with a round-like shape in the gastric body and homogeneous mild hypoattenuation on plain CT,the possibility of GS should be raised.Pathological and immunohistochemical examinations are necessary to confirm the final diagnosis.

关 键 词：神经鞘瘤 误诊 漏诊 体层摄影术 X线计算机 

分 类 号：R735.2[医药卫生—肿瘤]