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目的探讨64层螺旋CT对胃间质瘤(GST)的诊断价值。方法收集2010年5月至2011年8月期间四川大学华西医院32例经手术病理证实的GST,按Fletcher恶性风险分级表进行恶性风险分级,回顾性分析其CT表现,通过病灶部位、大小、边界、形态、密度、生长方式、有无转移、增强后强化特点等分析CT征象与GST恶性风险间的关系。结果本组32例GST均为单发病灶,CT定位准确率为100%。腔内型9例,腔外型10例,腔内外型13例。低危组9例,直径均<5 cm,形态呈圆形或椭圆形,边界清楚,密度均匀,强化大多均匀(7/9);高危组23例,直径≥5 cm者19例,多呈不规则状、分叶状、边界不清楚(18/23),密度多不均匀(20/23),见囊变、坏死,6例可见溃疡,增强后实性部分呈渐进强化。高危组GST中3例邻近胰腺、脾脏受侵,2例伴左侧膈肌受累,1例伴大网膜转移,2例伴肝转移,1例病变旁淋巴结转移。结论多层螺旋CT是目前检查GST的最佳手段,其CT表现特征与恶性风险程度之间存在一定关系,可以为GST的术前恶性风险分析提供一定参考价值。
Objective To investigate the diagnostic value of 64-slice spiral CT in the diagnosis of gastric stromal tumor (GST). Methods 32 patients with pathologically confirmed GST at West China Hospital of Sichuan University from May 2010 to August 2011 were retrospectively analyzed for malignant staging according to the Fletcher Malignant Risk Scale. The CT features were analyzed retrospectively. The location, size, , Morphology, density, growth pattern, presence or absence of metastasis, enhanced and enhanced characteristics of the relationship between CT signs and malignant GST risk. Results The 32 cases of GST were single lesions, CT accuracy was 100%. 9 cases of intracavitary, 10 cases of extracavitary, 13 cases of intracavitary and external. In the low-risk group, 9 cases were all with a diameter less than 5 cm and the shape was round or oval with clear boundary, uniform density and mostly uniform enhancement (7/9). In the high-risk group, there were 23 cases with diameter≥5 cm in 19 cases Irregular, lobulated, the border is not clear (18/23), the density is not uniform (20/23), see cystic change, necrosis, ulcers were seen in 6 cases, enhanced solid part was enhanced. In the high-risk group, 3 cases were adjacent to the pancreas and spleen, 3 cases had left diaphragm involvement, 1 case had omentum metastasis, 2 cases had hepatic metastasis and 1 case had para-lymph node metastasis. Conclusions Multi-slice spiral CT is the best method to check GST at present, and there is a certain relationship between the CT features and the degree of malignant risk. It can provide some reference value for the preoperative malignant risk analysis of GST.