小肠平滑肌肉瘤的影像学诊断

目的 探讨小肠平滑肌肉瘤的X线钡剂造影表现、B超及CT的特征。方法 分析了经手术病理证实的31例小肠平滑肌肉瘤的影像学表现。其中26例行钡餐造影检查，11例行钡灌肠检查，25例行B超检查，17例行CT扫描。结果 8例腔内型钡餐造影见肠腔内肿物。黏膜展平呈弧形，管腔增宽，管壁不整，3例有小溃疡龛影。7例腔外型X线钡剂造影可见肠道受压移位改变，局部肠壁不整，13例腔内外型钡餐造影表现为腔内充缺，黏膜紊乱，管腔狭窄，6例有溃疡穿孔。B超22例发现腹部不规则软组织肿块，内部回声不均，10例肿物内有肠气反射。CT扫描发现腹内肿物12例，4例肿物内见有造影剂渗入。结论 X线钡剂造影仍是小肠平滑肌肉瘤简便的首选检查方法，B超、CT亦为重要的补充检查，特别是对于腔外型和腔内外型病变，恰当地结合应用可以提高小肠肿瘤的诊断准确率。

Image Diagnosis of Small Intestinal Leiomyosarcoma

Objective To study the radiographic, B-US and CT manifestations of small intestine leiomyosarcoma. Methods Thirty-one cases of surgically and pathologically proved small intestinal leiomyosarcoma were reviewed. Gastrointestinal barium radiography was performed in 26 cases, barium enema in 11 cases, B-US in 25 cases, and CT in 17 cases. Results Barium meal examination showed intraluminal filling defects and displaced mucosal folds in the intraluminal type.Six cases of mixd (both intra-luminal and extra-luminal) type showed ulceration of the mucosa and fistula formation. B-US showed large soft tissue mass in 22 cases, in which gas shadow was found in the mass in 10 cases. On CT scans soft tissue mass was founed in 12 cases. Conclusion In the diagnosis of small intestinal leiomyosarcoma, X-ray barium meal is the first choice. As an important supplement, sonography, CT scan are especially useful in detecting the lesion of extraluminal or mixed type. A combination of X-ray, sonography and CT can improve the clinical diagnosis of small intestinal leiomyosarcoma. [