小肠间质瘤的多层螺旋CT诊断

目的:探讨多层螺旋CT(MSCT)对小肠胃肠道间质瘤(GIST)的诊断价值。方法:回顾性分析经手术病理及免疫组化证实的26例小肠GIST的MSCT表现及特点,所有病例均行CT增强扫描和三维重建观察。结果:本组26例中,发生于十二指肠5例,空肠9例,回肠7例,肠系膜5例。其中,良性及低度恶性10例,恶性16例。肿瘤强化密度均匀4例,均为良性及低度恶性,强化后密度不均匀22例,其中良性及低度恶性6例,恶性16例。肿瘤≤5cm者7例,6例为良性及低度恶性,1例为恶性。肿瘤5cm者19例,其中良性及低度恶性4例,恶性15例。其中恶性GIST出现坏死内气体2例,溃疡2例,肠系膜脂肪间隙密度增高3例,出血1例,腹腔及肝脏转移5例。结论:MSCT对于判断小肠GIST的良恶性无明显优势,但对于肿瘤的早期发现、形态评估、血供特点、治疗方案选择及术后随访具有重要价值。

Diagnostis of small-bowel stromal tumors in multi-slice spiral CT

Objective：To discuss the diagnostic value of small-bowel stromal tumors in multi-slice spiral CT.Methods：Retrospectively analyzed manifestation and features in MSCT of twenty six cases with small-bowel GISTs confirmed by surgery,pathology and immunohistochemistry.Contrast enhanced CT and three-dimensional reconstruction in all cases were performed.Results：Of all the 26 cases in our series,5 were located in duodenum,9 in ileum,7 in jejunum and 5 in mesentery.10 cases were benign or low potential malignant,and 16 cases were malignant.4 cases with homogenous contrast enhancement were benign or low potential malignant,and in 22 cases with heterogeneous enhancement,there were 6 benign or low potential malignant cases and 16 malignant cases.In 7 the maximum diameter ≤5 cm,there were 6 benign or low potential malignant cases and 1 malignant cases.In 19 the maximum diameter 5 cm,there were 4 benign or low potential malignant cases and malignant cases.The malignant GISTs showed 2 gas in necrotic areas,2 with ulcer,1 with hemorrhage and abdominal or liver metastases in 5 cases.Conclusion：MSCT appears no obvious advantages in the differential diagnosis of GISTs,however it plays an important role in early discovery,morphology assessment,characteristic of blood supply,pretherapeutic evaluation and post-operative follow up.