胃神经鞘瘤CT表现及误诊分析（附12例）

目的:分析12例胃神经鞘瘤（gastric schwannoma,GS）的CT表现，提高对该肿瘤的认识。方法:回顾性分析本院2012年1月至2019年5月经手术及免疫组化证实的GS患者共12例，搜集临床及影像学资料，所有患者术前均行CT检查，其中5例仅行CT增强检查，7例行CT平扫及增强检查。结果:12例肿瘤最大径1.0~6.4 cm，12例均表现为单发的类圆形、类椭圆形肿块或结节，生长于胃体8例，胃底2例，胃窦2例。4例有溃疡形成，2例存在钙化。12例中3例腔内生长，3例腔外生长，6例为跨壁生长。CT增强扫描均呈渐近性强化，静脉期CT值平均增加14.58 HU。结论:GS好发于中老年女性，在CT上常表现为孤立性、界限清楚的肿块，多位于胃体，一般很少出现坏死囊变，CT增强扫描呈渐近性强化。但这些特点尚缺乏特异性，GS与其他胃部肿瘤，尤其是胃黏膜下肿瘤易相混淆，术前诊断较为困难。最终确诊需要病理及免疫组化检查。

CT manifestations and misdiagnosis of 12 cases of gastric schwannoma

Objective:To analyze the CT manifestations of 12 cases of gastric schwannoma (GS) in order to improve the understanding of the tumor.Methods:12 cases of gastric schwannomas confirmed by surgery and pathology from January 2012 to May 2019 in our hospital were analyzed retrospectively.Clinical and imaging data were collected.All patients performed CT examination before operation，5 cases of which were performed contrast CT while 7 were performed NCCT and contrast CT scanning.Results:The largest diameter of the tumor was 1.0~6.4 cm in 12 cases.All of the 12 cases presented as a single round or oval like mass or nodule.8 cases grew in the gastric body,2 cases in the fundus of the stomach and 2 cases in the antrum of the stomach.Ulceration was found in 4 cases and calcification in 2 cases.These lesions include endoluminal growth in 3 cases，exophytic growth in 3 cases and mixed growth in 6 cases.CT enhanced scan showed asymptotic enhancement，with an average increase of 14.58 HU in venous phase.Conclusion:GS is prone to occur in middle-aged and old women.It usually presents as an isolated and well-defined mass,mostly in the gastric body and necrotic cysts are rarely seen.CT enhanced scan shows progressive enhancement.However，these characteristics are not specific.GS is easy to be confused with other gastric tumors，especially submucosal tumors.It is difficult to diagnose GS before operation.The final diagnosis needs pathological and immunohistochemical examination.