胃间质瘤:螺旋CT表现与手术病理对照

目的:分析胃间质瘤的螺旋CT表现,评价螺旋CT鉴别胃间质瘤良恶性价值。方法:对29例胃间质瘤患者行螺旋CT扫描,对肿瘤的部位、大小、形态、增强特点、肿瘤与邻近器官的关系及有无转移进行回顾性分析,结果与手术病理对照。结果:良性6例,交界性5例,恶性18例。CT表现:肿物多具有壁在性、外生性特点(23例),腔内型6例。除5例良性肿物密度均匀外,其余均表现密度不均匀。6例高度恶性肿物表现边缘强化,中心大片低密度。病理所见:肿瘤实性部分为由梭形细胞和(或)上皮样细胞组成,变性、出血、囊变及坏死在CT均表现为低密度。肿物内伴斑点样钙化1例。胰腺、脾受侵各1例,胃壁受侵7例。多平面重建图像(MPR)排除横断面诊断胰岛细胞瘤和肝癌各1例。合并肝转移2例,淋巴结转移1例。结论:胃间质瘤的CT表现与其病理组织学相关。螺旋CT特别是MPR图像,在肿瘤的检出、判断肿瘤与周围器官的关系及有无转移上发挥重要作用,在判断肿瘤的良恶性上仍有困难。

Gastric stromal tumor: spiral CT findings with pathologic correlation

Objective:To assess spiral CT findings to assist in the distinction of benign and malignant gastric stromal tumors.Methods:Twenty nine patients with gastric stromal tumor underwent spiral CT. Images were assessed retrospectively for tumor location, size, morphology, enhancement features, relationships to the surrounding organs, and metastasis.Results:Six patients as benign, five as borderline, and eighteen as malignant. They most commonly had an exophytic growth pattern(n=23), and intraluminal masses(n=6). Most tumors showed heterogeneous in density except five patients with benign tumors. There were central low attenuating areas in the masses as well as peripheral enhancement in six patients with high-grade malignancy. Correlation of this appearance with pathologic findings demonstrated that peripheral areas represented solid portions composed of spindle and(or) epithelioid cells, central areas of low attenuation corresponded to degeneration, hemorrhage, cyst formation, or necrosis. Punctate calcification was noted in one patient. The invasion of pancreas, spleen, and gastric wall was seen respectively in one, one ,and seven patients. Hepatic metastasis in two patients and lymphadenopathy in one patient were identified. The diagnosis of insulinoma and hepatic carcinoma made respectively by transverse images in one patient was changed correctly by multiplanar reconstruction(MPR) images.Conclusion:The CT features are corresponded well with histopathologic findings. CT, and especially by MPR images, plays an important role in the detection, relationships to the surrounding organs, and metastasis. CT might be able to suggest benign or malignant, but it is difficult to differentiate.