CT在胃肠道间质瘤诊断及侵袭性评价中的应用价值

目的 分析CT在胃肠道间质瘤（GIST）诊断及侵袭性评价中的应用价值.方法 回顾性分析72例经螺旋CT检查后经手术或病理证实的GIST患者的临床资料,通过肿瘤生长部位、方式、强化形式、平扫及双期增强的CT值等评价肿瘤侵袭性.结果 GIST最常发生于胃.72例GIST中14例误诊,5例未作出明确定性诊断.肿瘤同一部位不同GIST危险度分级动脉期与平扫差值与静脉期与平扫差值比较差异均有统计学意义（t=4.2,3.5,13.1,15.8,P＜ 0.05）.肿瘤同一部位不同GIST危险度分级平扫、动脉期、静脉期CT值及动脉期与平扫差值和静脉期与平扫差值比较差异均无统计学意义（t=34.8,28.5,39.4,32.2,40.1,P＞ 0.05）.重建图像显示肿瘤与其周围组织的关系及肿瘤供血动脉,其中33例存在门静脉侧支,18例存在动静脉瘘,17例伴肝脏转移.结论 侵袭性不同的GIST双期增强CT扫描,动静脉期肿瘤均明显强化;后处理技术可帮助明确GIST的供血血管及与邻近血管与组织的关系,术前需综合多方面影像学信息进行分析,以做出正确的定位与定性诊断.

Application value of CT in the diagnosis and invasive evaluation of gastrointestinal stromal tumors

Objective To analyze the application value of CT in the diagnosis and invasive evaluation gastrointestinal stromal tumors （GIST）.Methods The clinical data of 72 GIST cases examined by spiral CT scan and confirmed by surgery or pathology were analyzed retrospectively,evaluated the invasiveness by the tumor site,pattern,strengthen forms,plain and dual-phase enhanced CT scan value.Results GIST most commonly occurred in the stomach.Forteen cases were misdiagnosed in 72 cases of GIST patients,diagnosis of 5 cases was not made clearly.The differences between arterial,venous phase and scan difference in the same parts of different GIST classification were statistically significant （t =4.2,3.5,13.1,15.8,P 〈 0.05）.The GIST in the same part of the different risk classification scan,arterial,venous CT values;difference between the arterial and scan,venous and scan,the difference was not statistically significant （t =34.8,28.5,39.4,32.2,40.1,P 〉 0.05）.Reconstructed image could show the relationship among the tumor and its surrounding tissue and tumor feeding artery,the existence of which 33 cases of portal collateral,18 cases with the presence of arteriovenous fistula and 17 cases with liver metastasis.Conclusions Invasive different GIST dual-phase enhanced CT scans show that arteriovenous tumors are significantly enhanced;post-processing techniques can help clear the blood vessels and GIST relations with neighboring vessels and tissue imaging requires multi-disciplinary preoperative information analysis to make the right location and diagnosis.