胃肠道神经鞘瘤和间质瘤的CT表现对照分析

摘要

Objective To compare the CT findings of gastrointestinal schwannomas (GS) and gastrointestinal stromal tumors (GIST). Methods Clinical features, pathological characters and spiral CT findings of GS and GIST were retrospectively analyzed. Moreover, spiral CT findings of GS were compared with GIST. Results Of the 6 patients with GS, tumors were located in the stomach in 5 and duodenum in 1. The largest diameter of GS ranged from 16 to 70 mm (average, 43 mm). Five of the 6 tumors showed round,oval or oblate shape with smooth edges, and 1 tumor showed lobulation and adherence to the adjacent organs. Unenhanced or contrast-enhanced CT showed homogeneous solid masses in all tumors, without hemorrhage, necrosis, cystic degeneration and calcification. Among the 29 patients with GIST,tumors originated in the stomach in 15, duodenum in 5 , small intestine in 8 and colon in 1. Lesions were oval or irregular in shape. Tumors appeared as homogeneous dense solid in 7 cases,heterogeneous dense solid in 14, cystic and solid mixture in 8,and hemorrhage in 1. Enhanced CT scans showed homogeneous enhancement in 4 cases, heterogeneous enhancement with spot-like necrosis in 3, and marked heterogeneous enhancement with different degree of central necrosis in 22. The diameter of GIST ranged from 30 to 200 mm. Growth pattern was endoluminal in 18 of the 29 GIST, exophytic in 8, and mixed in 3. Conclusion The morphology,enhancement degree and enhancement mode were significantly different between GS and GIST. The differences can diagnose and distinguish most cases.%目的 研究胃肠道神经鞘瘤的螺旋CT表现,并与胃肠道间质瘤(gastrointestinal stromal tumors,GIST)进行对照分析.方法 选取经手术病理证实的胃肠道神经鞘瘤6例及GIST 29例,回顾性分析其临床特征、病理特点及螺旋CT表现,并对其螺旋CT表现加以比较.结果 6例胃肠道神经鞘瘤中,5例发生于胃,1例发生于十二指肠.肿瘤最大直径16～70 mm,平均43 mm.5例肿瘤呈圆形、卵圆形或扁圆形,边缘光滑;1例呈分叶状,与邻近脏器粘连.所有肿瘤CT平扫及增强均呈均质实体肿块,未见明确出血、坏死、囊变及钙化征象.29例GIST中,发生于胃15例,十二指肠间质瘤5例,小肠间质瘤8例,结肠间质瘤1例.肿瘤呈类圆形或不规则形,密度均匀实性者7例,不均匀实性者14例,囊实性混合者8例,其中1例合并出血.增强扫描有4例均匀强化;3例不均匀强化,内有斑点状囊变坏死灶;22例呈不均匀明显强化,肿块内可见不同程度的囊变、坏死区.肿块直径约30～200 mm.18例肿瘤向腔外生长,8例向腔内生长,3例向腔内外生长.结论 胃肠道神经鞘瘤和GIST肿瘤的形态、强化程度和增强模式明显不同,该差异可以诊断和鉴别两者多数病例.