多层螺旋CT及数字减影血管造影对小肠间质瘤的诊断价值

目的探讨MSCT与DSA对小肠胃肠道间质瘤（GIST）的诊断价值。方法回顾性分析经病理证实的19例小肠GIST患者的MSCT资料及其中6例患者的DSA特征。结果MSCT表现：19例中,病灶位于空肠16例,位于回肠2例,位于空回肠交界处1例;单发17例,多发2例。6例低危GIST肿瘤呈类圆形或椭圆形,边界清;其中4例密度均匀,2例密度不均;瘤内片状低密度及点状钙化各1例。5例中危GIST肿瘤呈分叶状或不规则形,边界欠清,密度不均。8例高危GIST肿瘤呈分叶状、不规则形,与周围组织间分界不清;1例密度均匀,7例密度不均;多发病灶2例,单发6例;4例瘤内可见多发不规则低密度,2例可见局限性低密度区,1例可见点状钙化。低、中、高危险度GIST动脉期瘤体均明显强化,静脉期持续强化。DSA表现：6例病灶内均可见异常血管及肿瘤染色,其中4例肠系膜上动脉1条分支增粗,远段血管分支增多、紊乱,2例肠系膜上动脉2条或3条血管分支增粗,远段见球形包绕征。结论 MSCT可清晰显示肿瘤的大小、形态、密度、边缘及强化情况,可为小肠GIST危险程度的预判提供有价值的信息;DSA可精确定位、定量肿瘤供血动脉,客观显示肿瘤的血供变化。

Value of MSCT and digital subtraction angiography in diagnosis of small bowel gastrointestinal stromal tumors

Objective To explore the value of CT and DSA in diagnosis of small bowel gastrointestinal stromal tumors (GIST). Methods Imaging data of 19 patients with surgical pathology confirmed GIST were analyzed retrospectively, including MSCT findings of all 19 cases and DSA features of 6 cases. Results MSCT manifestations: There were 16 cases with GIST lesions in jejunum, 2 with ileum lesions and 1 case with the lesion in the juncture of jejunum and ileum. Single lesion was found in 17 cases, while multiple lesions were found in 2 cases. Spherical or oval mass with well-defined margin was detected in 6 cases of low risk GIST, while homogenous density lesions were found in 4 cases and inhomogeneous density lesions were found in 2 cases. Patchy low-density area was observed in 2 cases, and calcification was found in 1 case. Five cases of moderate risk GIST manifested as slightly lobulated or irregular masses with blurred margins, and the densities were inhomogeneous. Eight cases of high risk GIST appeared as lobulated or irregular masses with ill-defined margins, and there were 6 cases with single lesion and 2 cases with multiple lesions. Homogenous and inhomogeneous densities were found in 1 and 7 cases, respectively. There were multiple low-density areas in 4 cases, local low-density areas in 2 cases and spotted calcification in 1 case. Obvious enhancement in the arterial phase and continuously enhanced in the vein phase were observed in all GIST lesions. DSA manifestations: There were abnormal blood vessels and tumor staining in all 6 cases who underwent DSA examination, and thickening of one branch of superior mesenteric artery and the disordered enlargement of the branches of distal segment of blood vessel were found in 4 cases, as well as thickening of 2 or 3 branches of superior mesenteric artery and the surrounding signs were found in 2 cases. Conclusion MSCT can provide useful information for the pre-judgement of GIST risk level, including the size, shape, density, margin and enhancement of the tumors. DSA can precisely locate and quantitate the feeding arteries of tumors and reflect the changing of blood supply.