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：

胃腸道間質瘤; 體層攝影術; CT

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【摘要】　目的　分析胃腸道間質瘤（gastrointestinal stromal tumors，GIST）的螺旋CT（multi-detector row spiral computeel Tomography，MSCT）表現，評價其對該病的診斷價值。　方法　回顧性分析2000年3月—2010年10月經手術病理證實的32例GIST的MSCT表現，并將其與病理的生物學危險性進行對比研究。　結果　病理高、中、低及極低危險性GIST依次為15、6、7、4例。GIST主要CT表現，腫塊腔外生長為主，大部分病灶邊界清楚，呈類圓形或分葉狀，密度均勻或不均勻，3例可見鈣化，GIST增強靜脈期強化較動脈期更明顯，局部均無淋巴結轉移，轉移到肝臟的4例，同時伴前腹壁轉移1例。15例腫塊長徑≥5 cm，密度多不均勻，可有囊變、壞死、出血等，增強不均勻強化，其中11例病理為高風險性；17例腫塊長徑 lt;5 cm的病灶中，大多中度均勻強化，其中13例為中度及以下危險性。　結論　 GIST患者的MSCT表現具有一定的特征性，MSCT對準確定位、術前估計腫瘤的風險級別、術后隨訪有重要價值。
【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.
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.
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6.	張龍江, 楊亞英, 祁吉, 等. 胃腸道間質瘤的影像學表現[J]. 放射學實踐, 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.	孫雪峰, 張曉鵬, 唐磊, 等. 惡性胃腸道間質瘤的CT影像特點研究[J]. 中國實用外科雜志, 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.	周志剛, 高劍波, 楊學華, 等. 胃腸間質瘤的螺旋CT征象與病理對照分析[J]. 實用放射學雜志, 2008, 24(7): 912-915.
14.	尹韻晗, 謝傳淼, 莫運仙, 等. 49例胃腸間質瘤多排螺旋CT表現與病理對照研究[J]. 癌癥, 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.	孫燁, 綦維維. 多層螺旋CT半定量診斷高危險程度胃腸道間質瘤[J]. 中國醫學影像技術, 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.	中國胃腸道間質瘤專家組. 中國胃腸道間質瘤診斷治療共識(2008年版)[J]. 臨床腫瘤學雜志, 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. 　張龍江, 楊亞英, 祁吉, 等. 胃腸道間質瘤的影像學表現[J]. 放射學實踐, 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. 　孫雪峰, 張曉鵬, 唐磊, 等. 惡性胃腸道間質瘤的CT影像特點研究[J]. 中國實用外科雜志, 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. 　周志剛, 高劍波, 楊學華, 等. 胃腸間質瘤的螺旋CT征象與病理對照分析[J]. 實用放射學雜志, 2008, 24(7): 912-915.
14. 　尹韻晗, 謝傳淼, 莫運仙, 等. 49例胃腸間質瘤多排螺旋CT表現與病理對照研究[J]. 癌癥, 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. 　孫燁, 綦維維. 多層螺旋CT半定量診斷高危險程度胃腸道間質瘤[J]. 中國醫學影像技術, 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. 　中國胃腸道間質瘤專家組. 中國胃腸道間質瘤診斷治療共識(2008年版)[J]. 臨床腫瘤學雜志, 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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