39例胃黏膜下肿瘤CT诊断

目的:分析胃黏膜下肿瘤(gastric submucosal tumors,SMTs)的CT表现,以提高对该类病变的认识。方法:回顾性分析39例经术后病理证实的SMTs患者的CT资料,分析总结其特征表现。结果:39例SMTs患者中,间质瘤(gastric stromal tumor,GST)19例,影像表现为圆形、椭圆形或分叶状肿块,肿块实性部分增强后呈均匀或不均匀中度至明显强化,静脉期强化程度高于动脉期,17例GST长轴与胃壁垂直,14例表面覆盖完整黏膜,4例病变出现钙化,所有患者胃周未见肿大淋巴结;神经鞘瘤6例,表现为密度均匀的肿块,较少出血、坏死及囊变,仅2例患者病灶表面有小溃疡形成,增强后呈中度至明显强化,2例患者病灶周围出现肿大淋巴结;淋巴瘤8例,表现为范围较广的胃壁增厚而无梗阻,病灶长轴与胃壁平行,强化不明显,7例胃周出现肿大淋巴结;异位胰腺6例,表现为扁平状肿块影,增强后明显强化,强化方式与正常胰腺类似,1例见中央导管征。结论:SMTs病灶多在CT图像上有特征性表现,CT检查及多平面重组可清晰显示病灶的形状、大小、强化方式及胃腔内外情况等,对SMTs的诊断及鉴别均具有重要意义。

Application of computed tomography in diagnosis of gastric submucosal tumors

Objective： To analyze the CT findings of gastric submucosal tumors（SMTs） for improving the understanding of these tumors. Methods： A retrospective analysis of the CT findings was performed in a series of 39 patients with pathologically confirmed SMTs. Results： Of the 39 patients, there were 19 gastric stromal tumor, showing round, oval,and lobulated mass. The solid portion of the mass showed homogeneous or heterogeneous moderate to high enhancement,and enhancement was higher in venous phase than in arterial phase. The long axis was perpendicular to the gastric wall in17 cases, 14 cases showed the tumor was covered by intact mucosa, and calcification was seen in 4 cases. There was not any enlarged lymph node around the stomach in all the cases. There were 6 cases of schwannoma, demonstrating as homogeneous mass with moderate to high enhancement without hemorrhage, necrosis or cysts; only 2 cases had ulcer surface.Perigastric enlarged lymph nodes were found in 2 cases. There were 8 cases of lymphoma, showing a wide range of gastric wall thickening and without lumen obstruction, enhancement was not prominent. The long axis of all the lesions were pa rallel to the gastric wall; enlargement of perigastric lymph nodes were found in 7 cases. There were 6 cases of ectopic pancreas, with CT sign of flat mass with high enhancement, the enhancement pattern was similar to normal pancreas. Central duct sign was found in 1 case. Conclusions： Imagings of SMTs show certain characteristics. CT scan and multiplanar reconstruction could clearly depict the lesion shape, size, enhancement pattern and the situation in and out the stomach,which is important for the diagnosis of SMTs.