多层螺旋CT、内镜及胃肠道造影对胃脂肪瘤诊断价值的比较

摘要

目的 比较多层螺旋CT(MSCT)、胃肠道造影、常规胃镜和超声内镜在胃脂肪瘤初诊的检出率和定性诊断准确率的差异,探讨MSCT在胃脂肪瘤诊断中的价值.方法 收集经病理证实的26例胃脂肪瘤患者作为研究对象,分析其临床、病理及影像学资料.26例患者中男6例,女20例,年龄41～82岁,平均61岁.26例患者均行常规胃镜、MSCT平扫及动态增强扫描检查,其中21例行超声内镜、12例行胃肠道造影检查.结果 MSCT、常规内镜初诊胃脂肪瘤的检出率分别为88.5％(23/26)和80.8％(21/26),均高于胃肠道造影的检出率(41.7％,5/12,P＞0.05).MSCT的定性诊断准确率为100％(23/23),高于超声内镜(71.4％,15/21)、胃肠道造影(0％,0/5)和常规胃镜(0％,0/21),且超声内镜定性诊断的准确率高于胃肠道造影和常规胃镜.26例脂肪瘤位于胃窦18例(69.2％,前壁10例,后壁6例,幽门管2例),胃体7例(26.9％),胃底1例(3.8％).胃脂肪瘤MSCT表现均为边界清楚的类圆形或椭圆形结节影,呈均匀或混杂低密度,CT值在-50～-95Hu(平均-72.58Hu),增强扫描均无明显强化.肿瘤长径5.7～40.7mm(平均17.67mm),体积0.02～7.03cm3(平均1.89cm3).结论 MSCT能对胃脂肪瘤做出准确的定位及定性诊断.%Objective To compare the initial detection rate and the accuracy of qualitative diagnosis of multislice spiral computed tomography (MSCT),gastrointestinal tract radiography,gastroscopy,and endoscopic ultrasonography in the diagnosis of gastric lipoma,with a focus on evaluating the diagnostic value of MSCT.Methods Twenty-six patients with gastric lipoma,6 males and 20 females with a mean age of 61 years (ranging from 41 to 82 years) and confirmed by pathology,were enrolled in the present study.Their clinical,pathologic and imaging findings were retrospectively analyzed.All the patients underwent gastroscopy,and plain and dynamic enhanced MDCT scans.Of them 21 cases underwent endoscopic ultrasonography and 12 cases gastrointestinal tract radiography.Results The detection rate was 88.5％(23/26) and 80.8％(21/26),P＞0.05 for MSCT and gastroscopy,respectively,in the initial diagnosis of gastric lipomas,both higher than that of gastrointestinal tract radiography (41.7％,5/12).The accuracy of qualitative diagnosis of MSCT (100％,23/23) was higher than that of endoscopic ultrasonography (71.4％,15/21),gastrointestinal tract radiography (0％,0/5) and gastroscopy (0％,0/21).The lesions located at the gastric antrum in 18 cases (69.2％,including 10 front wall,6 posterior wall and 2 pyloric canal),the gastric body in 7 cases (26.9％) and the gastric fundus in 1 case (3.8％).All the lipomas presented as round or ovoid nodule with clear boundary on MSCT images,and homogeneous or mixed low density.The CT values,long dimensions and volumes ranged from-50 to-95Hu (mean-72.58Hu),5.7 to 40.7mm (mean 17.67mm) and 0.02 to 7.03cm3 (mean 1.89cm3),respectively.Contrast-enhanced CT scans showed no enhancement in all the lesions.Conclusion MSCT can make accurate locating and qualitative diagnosis for gastric lipomas.