CT增强扫描在腹内型侵袭性纤维瘤病和胃肠道间质瘤鉴别诊断中的价值

摘要

目的 探讨腹内型侵袭性纤维瘤病(IAF)CT增强扫描的特征,并分析与胃肠道间质瘤(GIST)的鉴别要点.方法 回顾性分析32例经病理证实的腹内型侵袭性纤维瘤病(IAF)和胃肠道间质瘤(GIST)的临床和影像资料,其中IAF和GIST分别16例.16例IAF中13例行三期增强扫描(包括2例复发病例),3例仅行双期增强扫描,16例GIST均行三期增强扫描,所有病例均有平扫CT图像,分别测量病灶在平扫、动脉期、静脉期或延迟期的密度,采用t检验,非参数检验和配对t检验的统计学方法分析病灶的强化程度以及强化方式,并分别获得两组病例的强化曲线.结果 16例IAF中14例单发,2例多发,1例两次复发;位于肠系膜2例,腹腔6例,腹膜后2例,盆腔5例,肾上腺区1例;IAF表现为动脉期和门静脉期较低的强化程度,以及延迟强化的特征,GIST表现为动脉期和门静脉期明显强化,延迟期强化程度减低,两者的强化程度以及强化方式鉴别有统计学意义(P<0.05).IAF的强化曲线呈上升型,GIST呈抛物线型.结论 增强CT能显示IAF的特征.IAF动脉期和门静脉期较低的强化程度、延迟强化的特征和强化曲线的类型对鉴别GIST有一定的帮助.%Objective To identify the CT features of intra-abdominal aggressive fibromatosis (IAF) and to analyze differential diagnosis from gastrointestinal stromal tumors (GIST).Methods The clinical and image data of 32 cases with pathology proved IAF (n=16) and GIST (n=16) were analyzed retrospectively.Unenhanced and contrast-enhanced examinations were performed in all cases of GIST and 13 cases of IAF.All cases were performed plain scan.CT attenuation on plain scan, arterial phase, venous phase or delayed phase were measured and calculated.The degree of enhancement and characteristics of enhancement were identified using grouped t-test, non-parametric test, pairing t-test, then achieving the enhancement curve of GIST and IAF, respectively.Results In the cases of IAF, single lesions were 14 cases, multiple lesions were 2 cases, the recurred in two times was 1 case, the mesenteric was 2 cases, the abdominal cavity was 6 cases, the retroperitoneal was 2 cases, the pelvic cavity was 5 cases, the adrenal area were 1 case.11 cases showed a kind of circular shape.5 cases were irregular shape, in which local boundary was not clear or unclear and the lesions were adhered to adjacent blood vessels, mesentery and organs.IAF showed lower degree of enhancement in the arterial phase and portal venous phase and the characteristics of delayed enhancement.GIST showed higher degree of enhancement in the arterial phase and portal venous phase and the degree of enhancement in the delayed phase was decreased.The degree of enhancement and characteristics of contrast enhancement between GIST and IAF had statistic significance(P<0.05).The contrast enhancement curve of IAF showed a ascending type and GIST showed a parabola type.Conclusion Enhancement CT can show the findings of IAF.IAF showed lower degree of enhancement in the arterial phase and portal venous phase, the characteristics of delayed enhancement and enhancement curve can help differential from GIST.