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目的评价螺旋CT及重建技术对腔外型胃间质瘤的诊断价值。方法收集浙江大学附属邵逸夫医院和浙江丽水市中心医院经手术病理和免疫组织化学证实为胃间质瘤共33例,对其中的17例腔外型间质瘤的螺旋CT表现进行回顾性分析。结果螺旋CT对17例腔外型胃间质瘤的定位、定性诊断正确率分别为88·2%和82·4%,其表现特征为:(1)与胃壁相连的腔外直径大于5cm分叶状肿块具有“钻角”征象者13例。(2)肿块密度不均,15例动态3期增强扫描动脉期呈轻、中度不均匀强化,门脉期及平衡期明显强化;2例动脉期明显强化,门脉期减退。(3)腔内肿块边缘有大小不一龛影者11例,腔外肿块边界不清,邻近结构侵犯者9例。(4)肿块与胃壁宽基相接或不可完全分割区。(5)周围组织器官侵犯是恶性间质瘤的征象。结论在综合临床表现与主要CT征象的基础上,螺旋CT及重建技术对腔外型胃间质瘤的定位、定性诊断具有重要价值。
Objective To evaluate the value of spiral CT and reconstruction in the diagnosis of extra-cavity gastric stromal tumors. Methods A total of 33 cases of gastric stromal tumors confirmed by surgery and pathology and immunohistochemistry were collected from Run Run Shaw Hospital of Zhejiang University and Central Hospital of Lishui. The spiral CT findings of 17 cases of them were retrospectively analyzed . Results The accuracy of spiral CT in the diagnosis and treatment of 17 cases of extrastromal stromal tumors was 88.2% and 82.4% respectively. The characteristics of spiral CT were as follows: (1) Leaf tumor with “drill angle” signs in 13 cases. (2) The density of lumps was not uniform. In the 15 cases of dynamic 3-phase enhanced scanning, the arterial phase showed mild and moderate inhomogeneous enhancement with marked enhancement in portal phase and balance phase. The arterial phase was significantly enhanced in 2 cases and the portal phase was decreased. (3) There are 11 cases with different size and shadow in the edge of the lump. The border of the lump is unclear, and 9 cases are adjacent to the structure. (4) mass and stomach wall wide base phase or not fully partitioned. (5) surrounding tissue and organ invasion is a sign of malignant stromal tumors. Conclusion Based on the comprehensive clinical manifestations and the main CT findings, spiral CT and reconstruction techniques are of great value in the localization and qualitative diagnosis of extra-cellular gastric stromal tumors.