目的：回顾性分析胃肠道间质瘤（GIST）的常规超声图像特征，探讨常规超声鉴别高复发风险GIST的诊断价值。资料与方法回顾性分析经手术及病理证实为GIST的72例患者的超声图像，观察肿块大小、形态、边界、内部回声及血流情况，并与临床病理对照。结果72例患者中，病灶位于胃34例，小肠14例，结肠2例，直肠8例，肠系膜9例，腹膜后1例，网膜1例，肿块巨大未明确来源3例。极低度复发风险7例，低度复发风险14例，中度复发风险11例，高度复发风险40例。将前3组合并为非高度复发风险组与高度复发风险组比较，病灶最大径≥5.0 cm、形态不规则、边界不清晰、囊实性差异有统计学意义（P<0.001），而不均匀低回声及血流差异无统计学意义（P>0.05）。以病灶最大径≥5.0 cm、形态不规则、边界不清晰、囊实性作为诊断高度复发风险的鉴别指标，敏感度分别为95.0%（32/40）、72.5%（29/40）、25.0%（10/40）、55.0%（22/40）；特异度分别为59.4%（19/32）、81.3%（26/32）、90.6%（29/32）、87.5%（28/32）。结论常规超声可以作为诊断GIST的筛查手段，并且可根据肿物大小、形态、边界以及内部是否为囊实性混合回声对肿块恶性风险分级进行初步判断，对临床决策的做出和预后评估具有一定的价值。%Purpose To evaluate ultrasonography in diagnosis of high recurrence risk gastrointestinal stromal tumors (GIST) by retrospective studying the ultrasound (US) imaging features of GITS. Materials and Methods US features of 72 GIST cases confirmed histopathologically were retrospectively studied. The tumor size, shape, boundary, echogenicity and blood flow of GITS were observed and compared with the results of histopathology. Results Of all the 72 tumors, 34 were originated in the stomach, 14 in the intestine, 2 in the colon, 8 in the rectum, 9 in the mesentery, 1 in the posterior peritoneum, 1 in the omentum and 3 huge masses of non definite origin. There were 7 cases with very low recurrence risk, 14 cases with low risk, 11 cases with intermediate risk and 40 cases with high risk. High recurrence risk group showed no statistical difference in heterogeneous hypoechoes and blood flow (P>0.05), but showed significantly higher rates in following US features:size larger than 5.0 cm, irregular shape, obscure boundary and cyst-solid echogenecity (P<0.001), which showed the sensitivity of 95.0% (32/40), 72.5% (29/40), 25.0% (10/40), and 55.0% (22/40), respectively; and the specificity of 59.4% (19/32), 81.3% (26/32), 90.6% (29/32), and 87.5% (28/32), respectively. Conclusion US can serve as a mean of screening GIST. The recurrence risk can be evaluated based on the tumor size, shape, boundary and echogenecity to guide clinical decisions and prognosis evaluation.
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