十二指肠壶腹周围部间质瘤的MSCT表现及其临床意义

目的：探讨十二指肠壶腹周围部间质瘤（GIST）的CT表现及其诊断价值。方法：回顾性分析9例经手术或病理证实的十二指肠壶腹周围部间质瘤的CT表现。结果：9例中良性GIST1例,交界性1例,恶性7例（其中6例为中低度恶性）。病灶大小2.5m×3.0cm～10cm×10cm,平均4cm×6cm。MSCT平扫示瘤内出血2例,无出血7例;分叶8例,无分叶1例。增强扫描示病灶周边部不规则环状强化伴中央坏死6例,明显强化但不伴中央坏死3例;9例均表现为门脉期持续强化。胆总管轻度扩张2例,胰管轻度扩张3例。多种后处理方法相结合可清楚显示十二指肠壶腹部的解剖结构、病灶的位置、形状、大小及所致胰胆管扩张。结论：十二指肠壶腹周围部GIST诊断关键是准确定位和肿瘤强化方式,MSCT三维图像重组更有助于确定诊断和手术方式。

Clinical significance of MSCT manifestation for duodenal periampullary stromal tumors

Objective：To study the MSCT features of duodenal periampullary stromal tumors and enhance the ability of differential diagnosis.Methods：All 9 cases of duodenal periampullary stromal tumors were confirmed by surgery and histopathology,together with the MSCT features were reviewed retrospectively.Results：9 cases of duodenal periampullary stromal tumors included one benign（GIST）,one borderline and 7 malignant tumors.The tumor size ranged from 2.5cm×3.0cm to 10.0cm×10.0cm,with mean size of 4.0cm×6.0cm.Plain MSCT showed 2 cases of intratumorous hemorrhage but none in other 7,8 cases with lobulation but none in 1.Enhaned MSCT showed 6 cases with irregular rim enhancement accompanied by central necrosis,3 being markedly enhanced without central necrosis,and all 9 cases revealing specific persistant enhancement in the portal venous phase.Dilation of common bile duct（CBD）occurred in 2 cases and mild dilation of pancreatic duct（PD）displayed in 3 cases.Combined method of postprocessing could clearly demonstrate the anatomic structure of duodenal periampulla,location,shape,size of lesion and dilation of CBD or PD.Conclusion：The diagnostic key point of duodenal periampullary stromal tumor is the precise localization and enhancement pattern of the tumor,MSCT especially with 3D reformation provides rather more accuracy for diagnosis and detail in planning surgery.