胃肠道间质瘤的CT表现与病理分级的相关性研究

目的对不同分级胃肠道间质瘤（GIST）的计算机断层扫描（CT）征象进行对比分析,评价CT表现对GIST病理分级的作用。方法收集有完整CT及病理组织学资料的原发性GIST共58例,其中恶性41例,良性和交界性者17例,对照病理组织学与病理分级,分析其CT征象对GIST分级的作用。结果发生于小肠、直肠的GIST比来源于胃和食道的恶性可能性更大。50例GIST表现为向腔外及壁间生长,其中38例为恶性;肿瘤平均最大径为7.5 cm,最大径≥7.5 cm者共26例,其中恶性23例;呈分叶状生长的GIST 35例,其中恶性30例。所有良性或交界性的GIST边界清晰,19例恶性GIST边界不清或部分不清。所有的恶性GIST均呈不均匀强化,均见坏死,10例良性或交界性者不均匀强化,亦可见坏死。15例恶性GIST出现周围侵犯。5例肝转移,1例腹膜种植转移。肿瘤明显强化、肿瘤表面血管、瘤内粗大血管、肿瘤腔侧面黏膜强化环及肿瘤腔侧面出现溃疡这几个因素在两组之间差异均无统计学意义。结论 CT检查对GIST的术前诊断和病理分级的评估有重要的意义。

Correlation of computed tomography features with tumor grade of gastrointestinal stromal tumor

Objective To analyze the computed tomography（CT） features of the gastrointestinal stromal tumor（GIST） and to estimate the CT features for assisting the pathologic classification of GIST. Methods The data of fifty-eight patients with pathologically and immunohistochemically proven GISTs were collected,including 41 patients with malignant tumors and 17 patients with benign or malignant potential tumors,who underwent examination of CT for primary tumors. The effect of CT features to the classification of the GIST was analyzed. Results Malignant GISTs were significantly more common in the small intestine and rectum than in the stomach and esophagus. Fifty GISTs extending outside or among the wall,38 of them were malignant tumors. The mean tumor size was 7.5 cm. Twenty-six were larger than 7.5 cm and 23 of them were malignant. Thirty-five had irregular surface and among them,30 were malignant. All the benign or malignant potential tumors had clear boundary,and 19 cases of malignant GIST had unclear boundary. Forty-one of malignant GIST and 10 cases of benign or malignant potential tumors showed heterogeneous enhancement. All the malignant GIST and 10 of benign or malignant potential GIST demonstrated necrosis. Fifteen of malignant GIST demonstrated circumference invasion. Five patients had hepatic metastases and 1 had peritoneal dissemination. There were no significant differences between malignant and benign or malignant potential GIST about the tumor enhancement,tumor vessel,inner layer enhancement or ulcer. Conclusion CT plays an important role in the preoperational diagnosis and classification of GIST.