浸润型胃淋巴瘤和浸润型胃癌的多层螺旋CT表现

摘要

Purpose To explore the multi-slice helical CT findings and differential diagnosis of infiltrative gastric lymphoma (LGL) and infiltrative gastric carcinoma (LGC). Materials and Methods The CT imaging manifestations of 17 cases of LGL and 22 cases of LGC confirmed by pathology were analyzed retrospectively. Results Lesions' location and extent: there were 11 cases of LGL locating in gastric fundus,12 cases in gastric body, 10 cases in gastric antrum, and 11 cases had involvement of more than two locations. Out of the 22 cases of LGC, 6 cases located in gastric fundus,13 cases in gastric body, 20 cases in gastric antrum, and 13 cases had involvement of more than two locations. The extent of tumors were > 50% of gastric circumference in 12 cases of LGL and in 15 cases of LGC, respectively (P> 0.05). Thickness of gastric wall: the maximum thickness of LGL was (24.4+12.1) mm, which was thicker than (17.7+3.2) mm of LGC (P< 0.05). Density and enhancement pattern: CT demonstrated homogeneous density in 15 cases of LGL, and heterogeneous density in 2 cases, with sight or mild enhancement for three phases; while of LGC was of homogeneous density in 12 cases, of heterogeneous density in 10 cases, with significantly heterogeneous enhancement in 17 cases and homogeneous enhancement in 5 cases. Changes of gastric mucosa: only 1 case showed huge ulceration in LGL, while 14 cases showed ulceration in LGC. Changes of gastric cavity: stiffness of gastric wall in only 2 cases of LGL, while obvious stiffness of gastric wall with gastric cavity stricture in 17 cases of LGC (P = 0.000). Perigastric lymph nodes: enlarged lymph nodes at more than 2 sites were found in 7 cases of LGL, while only 2 cases of LGC (P< 0.05). Conclusion Three-phase multi-slice helical CT shows high value for diagnosis and differential diagnosis of LGL and LGC.%目的 分析浸润型胃淋巴瘤( LGL)和浸润型胃癌(LGC)的多层螺旋CT表现,提高其鉴别诊断水平.资料与方法 回顾性分析经病理证实的17例LGL和22例LGC的CT资料.结果 病变部位、范围:LGL累及胃底11例,胃体12例,胃窦10例；LGC累及胃底6例,胃体13例,胃窦20例；同时累及2个或2个以上部位:LGL11例,LGC13例.病灶侵犯胃周径＞50％者LGL 12例,LGC 15例,差异无统计学意义(P＞0.05).胃壁厚度:LGL为(24.4±12.1) mm,LGC为(17.7±3.2) mm,差异有统计学意义(P＜0.05).密度及强化:LGL密度均匀15例,三期增强主要呈均匀轻中度强化；LGC密度均匀12例,密度不均匀伴坏死10例；不均匀强化17例.黏膜:LGL仅1例病变处见深溃疡形成；LGC中14例见溃疡形成.胃腔改变:LGL胃壁僵硬2例；LGC胃壁僵硬、胃腔狭窄17例,差异有统计学意义(P=0.000).胃周肿大淋巴结:胃周2个区以上淋巴结肿大者LGL 7例,LGC2例,差异有统计学意义(P＜0.05).结论 多层螺旋CT三期动态增强扫描对诊断LGL和LGC具有较高的临床价值.