胃神经鞘瘤与胃间质瘤的CT诊断与鉴别诊断
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摘要
目的探讨胃神经鞘瘤和胃间质瘤CT影像表现,提高对二者的认识和鉴别水平。方法回顾性分析经手术病理证实的6例胃神经鞘瘤和38例胃间质瘤的临床及CT影像资料,分析肿瘤大小、形态、生长方式、生长位置、强化模式及程度、囊变坏死、钙化并采用单因素方差分析(One-way ANOVA)和LSD法检验、Fisher's确切率统计学方法。结果胃神经鞘瘤与低中等危险度胃间质瘤在强化方式、强化程度及坏死、囊变上差异有统计学意义(P<0.05),与低中等危险度胃间质瘤在肿瘤大小上差异无统计学意义(P>0.05),与高度危险度胃间质瘤在肿瘤大小、形态、强化方式、强化程度及坏死、囊变上差异有统计学意义(P<0.05);胃神经鞘瘤与胃间质瘤发生钙化、生长位置及生长方式的差异无统计学差异(P>0.05)。结论胃神经鞘瘤与胃间质瘤在CT影像上存在差异:圆形、均匀强化、轻中度强化有利于神经鞘瘤诊断;分叶状、囊变坏死、不均匀强化、显著强化有利于间质瘤的诊断。
Objective To analyze the CT imaging features of gastrointestinal stromal tumors and gastric schwannoma, and to improve the recognition and identification. Methods The clinical and CT imaging data of 6 cases of GS and 38 cases of GIST were analyzed retrospectively. All the patients were confirmed by operation and pathology. The tumor size, morphology, growth mode, location, enhancement pattern and degree, cystic necrosis and calcification were analyzed. The variables were tested by completely random design(One-way ANOVA) and LSD, and Fisher 's exact test. Results The pattern and degree,necrosis and cystic change of GSs and low and moderate risk of GISTs were different(P<0.05), and the tumor size between the two groups had no difference(P>0.05), while the tumor size, shape, enhancement pattern, enhanced degree and cystic necrosis between the GSs and high degree of risk of GISTs was difference(P<0.05), the calcification, growth location and growth mode of the GSs and GISTs had no difference(P>0.05). Conclusion The imaging manifestation between GSs and GISTs were different, the sign of circular shape, homogeneous and moderate enhancement support the diagnosis of GS; and the sign of lobulated shape, cystic necrosis, heterogeneous enhancement support the diagnosis of GIST.
Objective To analyze the CT imaging features of gastrointestinal stromal tumors and gastric schwannoma, and to improve the recognition and identification. Methods The clinical and CT imaging data of 6 cases of GS and 38 cases of GIST were analyzed retrospectively. All the patients were confirmed by operation and pathology. The tumor size, morphology, growth mode, location, enhancement pattern and degree, cystic necrosis and calcification were analyzed. The variables were tested by completely random design(One-way ANOVA) and LSD, and Fisher 's exact test. Results The pattern and degree,necrosis and cystic change of GSs and low and moderate risk of GISTs were different(P<0.05), and the tumor size between the two groups had no difference(P>0.05), while the tumor size, shape, enhancement pattern, enhanced degree and cystic necrosis between the GSs and high degree of risk of GISTs was difference(P<0.05), the calcification, growth location and growth mode of the GSs and GISTs had no difference(P>0.05). Conclusion The imaging manifestation between GSs and GISTs were different, the sign of circular shape, homogeneous and moderate enhancement support the diagnosis of GS; and the sign of lobulated shape, cystic necrosis, heterogeneous enhancement support the diagnosis of GIST.
引文
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[12]Ji JS,Lu CY,Mao WB,et al.Gastric schwannoma:CT findings and clinicopathologic correlation[J].Abdominal Imaging,2015,40(5):1164-1169
[13]王冠军,王健,柯勤兵.胃神经鞘瘤的CT特征分析[J].医学影像学杂志,2017,27(1):83-85.
[14]徐慧新,徐青.胃神经鞘瘤和间质瘤的多排CT表现及对照研究[J].中国临床医学影像杂志,2015,26(1):18-22.
[2]Nishida T,Hirota S.Biological and clinical review of stromal tumors in the gastrointestinal tract[J].Histology&Histo-patholo gy,2000,15(4):1293-1301.
[3]Daimaru Y,Kido H,Hashimoto H,et al.Benign schwannoma of the gastrointestinal tract:a clinicopathologic and immunohistochemical study[J].Human Pathology, 1988,19(3):257-264.
[4]Melvin WS,Wilkinson MG.Gastric schwannoma.Clinical and pathologic considerations[J].AmericanSurgeon,1993,59(5):293-296
[5]Zheng L,Wu X,Kreis ME,et al.Clinicopathological and Immunohistochemical Characterisation of Gastric Schwannomas in 29 Cases[J].Gastroenterol Research&Practice,2014:1-7.
[6]胡明杰,张进,李建华,等.胃肠道间质瘤的CT诊断[J].中国CT和MRI杂志,2008,6(4):47-50.
[7]韦永春.胃间质瘤的CT诊断及危险度分析[J].中国CT和MRI杂志,2015,13(9):99-102.
[8]杨显金,陈佳慧,杜江,等.胃肠道间质瘤的诊治现状与进展[J].中国普外基础与临床杂志,2014,21(8):1040-1045.
[9]Dematteo RP,Ballman KV,Antonescu CR,et al.Adjuvant imatinib mesylate after resection of localised,primary gastrontestinal stromal tumour:a randomised,doubleblind,p lac ebocontrolled trial[J].Lancet,2009, 373(9669):1097-1104.
[10]陈岩,梁盼,高歌,等.多排螺旋CT对胃小间质瘤与胃小神经鞘瘤的鉴别诊断价值[J].实用放射学杂志,2014,30(9):1502-1505.
[11]王健,徐军良,厉锋,等.CT在(≤5cm)胃间质瘤和胃神经鞘瘤鉴别中的应用价值[J].临床放射学杂志,2017,36(2):236-240.
[12]Ji JS,Lu CY,Mao WB,et al.Gastric schwannoma:CT findings and clinicopathologic correlation[J].Abdominal Imaging,2015,40(5):1164-1169
[13]王冠军,王健,柯勤兵.胃神经鞘瘤的CT特征分析[J].医学影像学杂志,2017,27(1):83-85.
[14]徐慧新,徐青.胃神经鞘瘤和间质瘤的多排CT表现及对照研究[J].中国临床医学影像杂志,2015,26(1):18-22.