胃肠间质瘤MSCT三期扫描的CT诊断价值.doc

胃肠间质瘤MSCT三期扫描的CT诊断价值 正文 胃肠间质瘤MSCT三期扫描的CT诊断价值 文1：胃肠间质瘤MSCT三期扫描的CT诊断价值 [Abstract] Objective To analyze the diagnostic value of multi-slice spiral CT on gastrointestinal stromal tumo (GISTs). Methods Retrospectively analyzed both of the plain and three-phase dynamic enhanced CT features in 21 cases with whom were proved by pathology. Results The tumo originated from the stomach (n=11)， jejunum (n=4)， ileum (n=3)， mesentery (n=2)， esophagus (n=1). Of these， 3 cases were benign， 4 cases were conjunctional and 14 cases were malignant. The lesio were oval or irregular in shape. The tumo appeared as homogeneous dee solid (4 cases)， heterogeneous dee solid (9 cases)， cystic-solid mixed (8 cases)， one case calcification. Benign GISTs mainly appeared as small size， equable deity， smoothing border lines， while malignant GISTs mainly qualified as large size， heterogeneous deity， necrosis and cystic changes in the center; smoothly and lobulated border lines. The solid portion of tumo showed marked enhancement in the arterial and portal venous phase and in the equilibrium phase. The CT imaging of metastasis were similar as primary tumo. Conclusion Three-phase spiral CT examination can demotrate important features of GISTs， CT study is helpful for locating the tumor and observation of relatiohip of the tumor and surrounding structures。 [Key words] gastrointestinal stromal tumor; tomography; X-ray computed; three-dy namic enhanced scanning 胃肠间质瘤(gastrointestinal stromal tumo，GIST)是消化道最常见的原发性间叶性肿瘤[1]，在1983年由Magur和Clar[2]提出并命名独立起源于胃肠道间质干细胞的肿瘤，在此之前，由于医学局限性，误认为平滑肌瘤或神经源性肿瘤，直至1983年，由于病理免疫组化发展、普及，以及CT进步，使原来临床少见胃肠道间质瘤增多，现收集我院经手术病理证实的21例胃肠间质瘤，对其临床资料及CT表现进行回顾性分析，提高增强对胃肠间质瘤的认识，探讨其MSCT诊断价值。 材料与方法 1.病例资料 收集我院04年至今并手术治疗，有病理免疫组化结论的胃肠道间质瘤病例21例，男7例，女14例，年龄33～82岁，平均年龄57岁，按部位区分，胃11例，空肠4例，回肠3例，肠系膜2例，食道1例。临床症状腹部包块11例，腹痛10例，腹胀7例，便血6例。 设备与检查方法 设备采用日本Toshiba公司Aquiliom4排螺旋CT机，层厚、层间隔均为7mm，容积扫描，患者禁食8小时以上，上腹部扫描前中服温开水500ml。每例患者均行平扫及多期动态扫描，选用非离子型增强对比剂碘比醇，总量/kg，体重计算。注射流率，经肘静脉注射，动脉期25秒，门脉期50秒，平衡期90秒，延迟期120秒。部份患者增强