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目的探讨胃肠道间质瘤(GIST)术后肝转移的CT表现,并参照其病理组织免疫学,了解其恶性转移程度。方法回顾性分析10例经临床手术病理证实的胃肠道间质瘤(GIST)在随诊中或经肝穿活检证实的肝转移的CT影像表现及临床资料。主要观察胃肠道间质瘤术后的转移部位、数目、大小、形态、密度、强化程度等方面。结果病灶分布:肝右叶4例,左叶2例,两叶4例。单发3例;多发者7例,病灶以3~7个居多40%(4/10)。病灶直径1cm~23cm,以2cm~5cm居多(54.3%)(25/46),5cm以上17个(37.0%)(17/46)。CT平扫:多呈结节、肿块或厚壁囊性肿物。增强扫描:动脉期呈环状或线样、点状、斑片及絮状强化为主(60.9%)(28/46);门脉期:病灶实质部分强化,坏死液化区不强化,部分病灶呈“牛眼征”(17.4%)(8/46);延迟期:多数病灶强化渐消退,其密度低于周围肝实质78.3%(36/46)。结论胃肠道间质瘤(GIST)肝转移CT表现复杂多样,以单发、较大、边缘清楚的实性、厚壁囊性肿物,动脉期边缘或实质内线样或斑点及片絮状强化较具特征性,在原发肿瘤诊断不明的情况下,应积极行肝内病灶穿刺活检。
Objective To investigate the CT manifestations of postoperative liver metastases in patients with gastrointestinal stromal tumors (GIST), and to understand the degree of malignant metastasis with reference to their histopathology and immunology. Methods We retrospectively analyzed the CT findings and clinical data of 10 cases of liver metastasis confirmed by pathological examination of gastrointestinal stromal tumors (GIST) during follow-up or biopsy. The main observation of gastrointestinal stromal tumor after the transfer site, number, size, morphology, density, degree of enhancement and so on. Results The distribution of lesions: 4 cases of right lobe, 2 cases of left lobe and 4 cases of two lobe. Single in 3 cases; multiple in 7 cases, the lesions to 3 to 7 mostly 40% (4/10). Lesions diameter 1cm ~ 23cm, with 2cm ~ 5cm majority (54.3%) (25/46), 5cm more than 17 (37.0%) (17/46). CT scan: mostly nodules, mass or thick cystic mass. Enhanced scan: arterial phase was ring or line-like, punctate, patch and flocculation-based enhancement (60.9%) (28/46); portal phase: lesion enhancement in part, the necrosis liquefaction area is not enhanced, some lesions (17.4%) (8/46). Delayed period: most of the lesion intensified subsided and its density was lower than 78.3% (36/46) of the surrounding liver parenchyma. Conclusions The liver metastases of gastrointestinal stromal tumors (GISTs) are complex and diverse. Single, large, clear margins of solid, thick cystic masses, arterial phase edges or parenchyma or spots and flakes Strengthen the more characteristic, in the case of unknown diagnosis of primary tumors, should be active intrahepatic lesions biopsy.