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目的探讨多层螺旋CT(MSCT)对小肠间质瘤诊断和良恶性判断的价值,为临床选择治疗方案和预后提供依据。方法回顾性分析浙江省衢州市中医医院和浙江大学附属第一医院2006年4月至2016年4月共41例经手术及病理证实的小肠间质瘤MSCT征象与恶性度。用SPSS 19.0统计软件进行统计学分析,非正态分布的计量资料的比较用秩和检验,计数资料的比较用χ~2检验。结果 41例小肠间质瘤中良性间质瘤11例,潜在恶性间质瘤6例,恶性间质瘤24例。良性肿瘤直径为1.1~4.8 cm,中位数为2.5 cm;恶性肿瘤直径为1.8~30.2 cm,中位数为5.9 cm,差异有统计学意义(P<0.05)。23例小肠间质瘤边界不清,18例边界清晰,29例呈圆形及类圆形,12例形态不规则,有明显分叶。轻度强化病灶6例,中度强化病灶16例,明显强化病灶19例,其中19例可见供血动脉。12例肿瘤发生坏死,29例未见坏死。4例坏死区内见气体,5例合并腹腔内大量腹水,1例系膜淋巴结转移。MSCT对胃肠道间质瘤良恶性鉴别准确率为66.7%。结论 MSCT及重建技术能显示病变的特征及其与周围组织的关系,对小肠间质瘤的诊断及良恶性判断具有重要价值。
Objective To investigate the value of multi-slice spiral CT (MSCT) in the diagnosis and benign and malignant diagnosis of small intestinal stromal tumors and provide the basis for clinical treatment options and prognosis. Methods A retrospective analysis was made on the MSCT signs and malignancy of 41 cases of intestinal stromal tumors confirmed by operation and pathology from April 2006 to April 2016 in Zhejiang Medical University Hospital and the First Affiliated Hospital of Zhejiang University. SPSS 19.0 statistical software for statistical analysis, non-normal distribution of measurement data using rank sum test, comparison of count data with χ ~ 2 test. Results Of the 41 cases, 11 were benign stromal tumors, 6 were potential malignant stromal tumors and 24 were malignant stromal tumors. The diameter of benign tumors ranged from 1.1 to 4.8 cm, and the median was 2.5 cm. The diameter of malignant tumors ranged from 1.8 to 30.2 cm with a median of 5.9 cm. The difference was statistically significant (P <0.05). 23 cases of intestinal stromal tumor border is unclear, 18 cases of clear boundary, 29 cases were round and round, 12 cases of irregular shape, with obvious lobulation. Mild enhancement of lesions in 6 cases, moderate enhancement lesions in 16 cases, significantly enhanced lesions in 19 cases, of which 19 cases of visible blood supply artery. Tumor necrosis occurred in 12 cases and necrosis was not found in 29 cases. In 4 cases, gas was found in the necrotic area, 5 cases combined with a large amount of ascites in the abdominal cavity and 1 case of mesangial lymph node metastasis. The accuracy of MSCT in differentiating gastrointestinal stromal tumors was 66.7%. Conclusion MSCT and reconstruction techniques can show the characteristics of lesions and their relationship with the surrounding tissue, the diagnosis of small intestinal stromal tumors and benign and malignant judgment of great value.