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目的:探讨64排螺旋CT动态增强扫描结合后处理对胃肠道外间质瘤(extragastrointestinal stromal tumor,EGIST)的诊断价值。方法:回顾性分析8例经手术病理证实的EGIST CT表现及临床资料。所有病例均行64排螺旋CT动态增强扫描,包括平扫、动脉期、门静脉期和延迟期,扫描结束后在GE ADW4.4工作站行多平面重组(multiple planar reconstruction,MPR),观察肿块的大小、形态、边缘和强化程度,肿块周围和(或)内部有无血管影,肿块与邻近脏器的关系,分析肿块的来源与性质。结果:8例EGIST中,位于腹膜后3例,肠系膜3例,小网膜1例,肝脏1例。肿瘤最大径平均(11.0±2.4)(7.7~15.0)cm,圆形或卵圆形4例,分叶状3例,不规则形1例。平扫肿块内密度不均,见斑片状、瘢痕状及大片状坏死囊变区,囊变坏死部分CT值为25~28 HU,实性部分CT值为34~47 HU,增强后动脉期实性部分轻、中度强化3例,CT值较平扫增加15~22 HU;实性部分明显不均匀强化5例,CT值较平扫增加40~55 HU。门静脉期渐进性强化6例,CT值较动脉期增加10~25 HU。坏死区未见强化。增强后肿瘤周围和(或)内部可见线状扭曲血管影6例。结论:EGIST的影像学表现有一定特征性,多排螺旋CT动态增强结合MPR对于EGIST的定位与定性诊断有重要临床意义,建议为术前常规。
Objective: To investigate the diagnostic value of dynamic contrast-enhanced 64-slice spiral CT combined with post-processing in the diagnosis of extragastrointestinal stromal tumor (EGIST). Methods: Eight cases of pathologically confirmed EGIST CT and clinical data were retrospectively analyzed. All patients underwent 64-slice spiral CT dynamic contrast-enhanced scan, including plain scan, arterial phase, portal vein phase and delayed phase. After the scan, multiple planar reconstruction (MPR) was performed on GE ADW4.4 workstation to observe the size of the tumor , Morphology, margins and degree of enhancement, the presence of blood vessels around and / or within the tumor, the relationship between the mass and the adjacent organs, and the source and nature of the mass. Results: Among the 8 cases of EGIST, 3 were located in the retroperitoneum, 3 in the mesentery, 1 in the retina and 1 in the liver. The largest diameter of tumor was (11.0 ± 2.4) (7.7 ~ 15.0) cm, 4 were round or oval, 3 lobulated, and 1 irregular. Swelling uneven density within the mass, see the patchy, scar and large necrosis of the cystic area necrosis cystic necrosis CT value of 25 ~ 28 HU, the real part of the CT value of 34 ~ 47 HU, enhanced arteries In 3 cases, the CT value increased 15 ~ 22 HU compared with the plain scan. In 5 cases, the real part was markedly unevenly enhanced, and the CT value was 40 ~ 55 HU more than the plain scan. Portal venous progressive enhancement in 6 cases, CT value than the arterial phase increased 10 ~ 25 HU. Necrosis area has not been enhanced. After the enhancement of the tumor and (or) visible inside the twisted blood vessels in 6 cases. Conclusions: The imaging findings of EGIST have certain characteristics. The dynamic contrast-enhanced multi-slice spiral CT combined with MPR has important clinical significance for the localization and qualitative diagnosis of EGIST. The preoperative routine is recommended.