The Diagnostic Value of Multi-slice Spiral CT for Gastrointestinal Stromal Tumors_West China Medical Journal

Authors：

LIU Ling , TANG Yanlong , DU Wei

Department of Radiology, The Affiliated Hospital of Dali University, Dali, Yunnan 671000, P. R. China;

Corresponding author：

Keywords：

胃肠道间质瘤; 体层摄影术; CT

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【摘要】　目的　分析胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的螺旋CT（multi-detector row spiral computeel Tomography，MSCT）表现，评价其对该病的诊断价值。　方法　回顾性分析2000年3月—2010年10月经手术病理证实的32例GIST的MSCT表现，并将其与病理的生物学危险性进行对比研究。　结果　病理高、中、低及极低危险性GIST依次为15、6、7、4例。GIST主要CT表现，肿块腔外生长为主，大部分病灶边界清楚，呈类圆形或分叶状，密度均匀或不均匀，3例可见钙化，GIST增强静脉期强化较动脉期更明显，局部均无淋巴结转移，转移到肝脏的4例，同时伴前腹壁转移1例。15例肿块长径≥5 cm，密度多不均匀，可有囊变、坏死、出血等，增强不均匀强化，其中11例病理为高风险性；17例肿块长径 lt;5 cm的病灶中，大多中度均匀强化，其中13例为中度及以下危险性。　结论　 GIST患者的MSCT表现具有一定的特征性，MSCT对准确定位、术前估计肿瘤的风险级别、术后随访有重要价值。
【Abstract】　Objective　 To investigate the imaging features of multi-slice spiral CT (MSCT) for gastrointestinal stromal tumors (GIST) and its diagnostic value. 　Methods　 We retrospectively analyzed the MSCT manifestations of 32 cases of GIST confirmed by operation and pathology between March 2000 and October 2010. Comparative study was then carried out between MSCT manifestations and patho-physiological risks. 　Results　 Of the 32 GIST lesions, 15 presented with high biological risks, six moderate risks, seven low risks and four very low risks. The MSCT results manifested the following main features. Exophytic growth was predominating; Most lesions were with well-defined margins, and were rotund or lobular in shape with homogeneous or heterogeneous density. Three lesions manifested calcification. The enhancement degree of GIST in portal vein phase was more obvious than in arterial phase. There was no metastasis to local lymph nodes. Hepatic metastasis occurred in four cases, one of which was accompanied with anterior abdominal wall metastasis. Of the 15 lesions with maximal diameter longer than 5 cm, MSCT showed obvious cystic changes, necrosis or hemorrhage within the mass most of which was in heterogeneous density, and heterogeneous enhancement; Eleven out of the 15 lesions were at high risk. Among the 17 lesions with maximal diameter shorter than 5 cm, MSCT showed homogeneous enhancement, and 13 of them were at moderate risk or below. 　Conclusion　 The MSCT imaging of GIST manifests some certain characteristics. It is valuable in locating the lesion precisely, estimating the risk level of the tumor, and postoperative follow-up for patients with GIST.

Citation： LIU Ling,TANG Yanlong,DU Wei. The Diagnostic Value of Multi-slice Spiral CT for Gastrointestinal Stromal Tumors. West China Medical Journal, 2011, 26(5): 698-701. doi: Copy

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2.	Schubert ML, Moghimi R. Gastrointestinal stromal tumor(GIST)[J]. Curr Treat Options Gastroenterol, 2006, 9(2): 181-188.
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7.	Levy AD, Remotti H E, Thomp son WM, et al. Gastrointe-stinal stromal tumors: radiologic features with pathological correlation[J]. Radio Graphics, 2003, 23(2): 283-304.
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10.	Tateishi U, Hasegawa T, Satake M, et al. Gastrointestinal stromal tumors. Correlation of computed tomography findings with tumor and mortality[J]. J Comput Asssist Tomogr, 2003, 27(5): 792-798.
11.	Patel SR, Benjamin RS. Management of peritoneal and hepatic metastases from gastrointestinalstromal tumors[J]. Surg Oncol, 2000(9): 67-70.
12.	Sandrasegaran K, Rajesh A, Rushing DA, et al. gastrointestinal stromal tumors: CT and MRI findings[J]. Eur Raadiol, 2005, 15(7): 1407-1414.
13.	周志刚, 高剑波, 杨学华, 等. 胃肠间质瘤的螺旋CT征象与病理对照分析[J]. 实用放射学杂志, 2008, 24(7): 912-915.
14.	尹韵晗, 谢传淼, 莫运仙, 等. 49例胃肠间质瘤多排螺旋CT表现与病理对照研究[J]. 癌症, 2009, 28(9): 983-988.
15.	Yang TH, Hwang JI, Yang MS, et al. Gastrointestinal stromal tumors: computed features and prediction of malignant risk from computed tomographic imaging[J]. Chin Med Assoe, 2007, 70(9): 367-373.
16.	孙烨, 綦维维. 多层螺旋CT半定量诊断高危险程度胃肠道间质瘤[J]. 中国医学影像技术, 2010, 26(30): 517-520.
17.	Yeh CN, Chen TW, Wu TJ, et al. Treatment of patients with advanced gastrointestinal stromal tumor of smallbowel: implications of imatinib mesylate[J]. World J Gastroenterol, 2006, 12(23): 3760-3765.
18.	中国胃肠道间质瘤专家组. 中国胃肠道间质瘤诊断治疗共识(2008年版)[J]. 临床肿瘤学杂志, 2009, 14(8): 746-754.
19.	Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor[J]. Hum Pathol, 2008, 39(10): 1411-1419.
20.	Nillson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population study in western Sweden[J]. Cancer, 2005, 103(4): 821-829.
21.	Rimondini A, Belgrano M, Favretto G, et al. Contribution of CT to Treatment Planning in Patients with GIST[J]. Radiol Med, 2007, 112(10): 691-702.

1. 　Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gast rointestinal stromal tumors: a consensus approach[J]. Hum Pathol, 2002, 33(5): 459-465.
2. 　Schubert ML, Moghimi R. Gastrointestinal stromal tumor(GIST)[J]. Curr Treat Options Gastroenterol, 2006, 9(2): 181-188.
3. 　van Roggen JF, van Velthuysen ML, Hogendoorn PC. The histopathological differential diagnosis of gastrointestinal stromal tumors[J]. J Clin Pathol, 2001, 54(2): 96-102.
4. 　Lee HE, Kim MA, Lee HS, et al. Characteristics of KIT-negative gastrointestinal stromal tumours and diagnostic utility of protein kinase C theta immunostaining[J]. J Clin Pathol, 2008, 61(6): 722-729.
5. 　Mettinen M, Makhlouf H, Sobin LH, et al. Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up[J]. Am J Surg Pathol, 2006, 30(4): 477-489.
6. 　张龙江, 杨亚英, 祁吉, 等. 胃肠道间质瘤的影像学表现[J]. 放射学实践, 2006, 21(4): 362-365.
7. 　Levy AD, Remotti H E, Thomp son WM, et al. Gastrointe-stinal stromal tumors: radiologic features with pathological correlation[J]. Radio Graphics, 2003, 23(2): 283-304.
8. 　Sandrasegaran K, Rajesh A, Rydberg J, et al. gastrointestinal stromal tumors: clincical, radiological and pathologic features[J]. AJR, 2005, 184(3): 803-811.
9. 　孙雪峰, 张晓鹏, 唐磊, 等. 恶性胃肠道间质瘤的CT影像特点研究[J]. 中国实用外科杂志, 2009, 29(4): 327-330.
10. 　Tateishi U, Hasegawa T, Satake M, et al. Gastrointestinal stromal tumors. Correlation of computed tomography findings with tumor and mortality[J]. J Comput Asssist Tomogr, 2003, 27(5): 792-798.
11. 　Patel SR, Benjamin RS. Management of peritoneal and hepatic metastases from gastrointestinalstromal tumors[J]. Surg Oncol, 2000(9): 67-70.
12. 　Sandrasegaran K, Rajesh A, Rushing DA, et al. gastrointestinal stromal tumors: CT and MRI findings[J]. Eur Raadiol, 2005, 15(7): 1407-1414.
13. 　周志刚, 高剑波, 杨学华, 等. 胃肠间质瘤的螺旋CT征象与病理对照分析[J]. 实用放射学杂志, 2008, 24(7): 912-915.
14. 　尹韵晗, 谢传淼, 莫运仙, 等. 49例胃肠间质瘤多排螺旋CT表现与病理对照研究[J]. 癌症, 2009, 28(9): 983-988.
15. 　Yang TH, Hwang JI, Yang MS, et al. Gastrointestinal stromal tumors: computed features and prediction of malignant risk from computed tomographic imaging[J]. Chin Med Assoe, 2007, 70(9): 367-373.
16. 　孙烨, 綦维维. 多层螺旋CT半定量诊断高危险程度胃肠道间质瘤[J]. 中国医学影像技术, 2010, 26(30): 517-520.
17. 　Yeh CN, Chen TW, Wu TJ, et al. Treatment of patients with advanced gastrointestinal stromal tumor of smallbowel: implications of imatinib mesylate[J]. World J Gastroenterol, 2006, 12(23): 3760-3765.
18. 　中国胃肠道间质瘤专家组. 中国胃肠道间质瘤诊断治疗共识(2008年版)[J]. 临床肿瘤学杂志, 2009, 14(8): 746-754.
19. 　Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor[J]. Hum Pathol, 2008, 39(10): 1411-1419.
20. 　Nillson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population study in western Sweden[J]. Cancer, 2005, 103(4): 821-829.
21. 　Rimondini A, Belgrano M, Favretto G, et al. Contribution of CT to Treatment Planning in Patients with GIST[J]. Radiol Med, 2007, 112(10): 691-702.

West China Medical Journal

The Diagnostic Value of Multi-slice Spiral CT for Gastrointestinal Stromal Tumors

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