上消化道肉瘤样癌的CT特征及临床病理分析  

CT features and clinicopathologic analysis of sarcomatoid carcinoma of the upper gastrointestinal tract

作　　者：范儒阳 刘译阳 赵帅 尤亚茹 高剑波[1] FAN Ru-yang;LIU Yi-yang;ZHAO Shuai(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射科,河南郑州450052

出　　处：《放射学实践》2024年第12期1649-1654,共6页Radiologic Practice

基　　金：国家自然科学基金(81971615)。

摘　　要：目的:探讨上消化道肉瘤样癌(SC)的CT特征及临床病理特点,提高对该病的诊断水平。方法:回顾性分析2010年8月-2023年4月在本院经病理证实为上消化道肉瘤样癌的19例患者的CT(平扫及动脉期和门静脉期增强图像)和临床病理资料。由2位腹部影像诊断医师对CT图像进行观察分析,评估病灶的部位、形态、厚度与长径的比值、密度、黏膜表面有无溃疡,分析病灶的增强方式及强化程度等。结果:19例中男13例、女6例,年龄中位数为66岁;11例为食管肉瘤样癌,7例胃肉瘤样癌,1例十二指肠肉瘤样癌。病灶多位于食管中段及近端胃,分别为6例(6/11)及5例(5/7)。病灶长径为7.26~72.07 mm[平均(29.03±16.47)mm];厚度为3.04~50.51 mm[平均(18.41±10.95)mm];厚度与长径的比值为0.38~1.00[平均(0.65±0.19)]。肿瘤主要呈不均匀密度,平扫期CT值为13.83~60.83 HU[平均(35.42±12.57)HU],动脉期CT值为34.63~102.88 HU[平均(64.60±21.17)HU],门静脉期CT值为40.78~120.00[平均(74.17±19.63)HU]。1例病灶内可见钙化,13例可见邻近黏膜中断,14例可见肿瘤表面溃疡形成。增强扫描:肿瘤呈不均匀强化16例;肿瘤强化峰值在门静脉期16例;门静脉期图像上肿瘤呈轻度强化3例,中度强化8例,明显强化8例。结论:上消化道肉瘤样癌具有较大厚长比、平扫密度不均匀、坏死囊变常见以及多见于食管中段及近端胃的相对特征,但在CT扫描下的影像特征多呈现非特异性,明确诊断依靠组织病理学及免疫组化。Objective:The aim of this study was to investigate the CT and clinicopathologic features of sarcomatoid carcinoma(SC)of the upper gastrointestinal tract,and improve the understan-ding of this disease.Methods:CT images(including plain,arterial phase and portal venous phase images)and clinicopathologic information of 19 patients with pathologically confirmed upper gastrointestinal tract sarcomatoid carcinoma(SC)from August 2010 to April 2023 in our hospital were retrospectively analyzed.The imaging data was observed and analyzed by two radiologists specialized in abdominal imaging,assessing the location,morphology,ratio of thick to long diameter,density,presence of ulcers on the mucosal surface,and the enhancement mode and degree of the lesions.Results:Of the 19 patients,13 were male and 6 were female.The median age was 66 years.These 19 cases included 11 cases of esophageal sarcomatoid carcinoma,7 cases of gastric sarcomatoid carcinoma and one case of duodenal sarcomatoid carcinoma.The lesions were mostly located in the mid esophagus and proximal stomach in 6(6/11)and 5(5/7)cases,respectively,with lesion length ranging from 7.26 to 72.07mm with mean value of(29.03±16.47)mm,the thickness ranging from 3.04 to 50.51mm with mean value of(18.41±10.95)mm,and the ratio of the thickness to the length ranged from 0.38 to 1.00 with mean value of 0.65±0.19.The tumor was mainly heterogeneous in density,CT values were about 13.83 to 60.83HU with mean values of(35.42±12.57)HU in the plain phases,34.63 to 102.88HU with mean value of(64.60±21.17)HU in the arterial phase,and 40.78 to 120.00HU with mean value of(74.17±19.63)HU in the portal venous phases.Calcification was seen in one case,interruption of adjacent mucosa was seen in 13 cases,and ulcer formation on the tumor surface was seen in 14 cases.Enhancement scan:the tumor showed inhomogeneous enhancement in 16 cases;the peak of tumor enhancement was in the portal vein stage in 16 cases;the tumor on the portal venous phases images showed mild enhancement in 3 cases,moder

关 键 词：肉瘤样癌 上消化道肿瘤 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R735.1[医药卫生—放射医学] R735.2[医药卫生—临床医学]