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首页> 外文期刊>European Journal of Radiology >Differentiation of large (≥5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists' performance using CT
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Differentiation of large (≥5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists' performance using CT

机译:大(≥5 cm)胃肠道间质瘤与胃上皮下良性肿瘤的区别:放射科医师使用CT的表现

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摘要

Purpose To identify significant CT findings for the differentiation of large (≥5 cm) gastric gastrointestinal stromal tumors (GIST) from benign subepithelial tumors and to assess whether radiologists' performance in differentiation is improved with knowledge of significant CT criteria. Materials and methods One-hundred twenty patients with pathologically proven large (≥5 cm) GISTs (n = 99), schwannomas (n = 16), and leiomyomas (n = 5) who underwent CT were enrolled. Two radiologists (A and B) retrospectively reviewed their CT images in consensus for the location, size, degree and pattern of enhancement, contour, growth pattern and the presence of calcification, necrosis, surface ulceration, or enlarged lymph nodes. CT findings considered significant for differentiation were determined using uni- and multivariate statistical analyses. Thereafter, two successive review sessions for the differentiation of GIST from non-GIST were independently performed by two other reviewers (C and D) with different expertise of 2 and 9 years using a 5-point confidence scale. At the first session, reviewers interpreted CT images without knowledge of significant CT findings. At the second session, the results of statistical analyses were provided to the reviewers. To assess improvement in radiologists' performance, a pairwise comparison of receiver operating curves (ROC) was performed. Results Heterogeneous enhancement, presence of necrosis, absence of lymph nodes, and mean size of ≥6 cm were found to be significant for differentiating GIST from schwannoma (P < 0.05). Non-cardial location, heterogeneous enhancement, and presence of necrosis were differential CT features of GIST from leiomyoma (P < 0.05). Multivariate analyses indicated that absence of enlarged LNs was the only statistically significant variable for GIST differentiating from schwannoma. The area under the curve of both reviewers obtained using ROC significantly increased from 0.682 and 0.613 to 0.903 and 0.904, respectively, with information of the significant CT findings differentiating GISTs from non-GISTs (P < 0.001). Conclusion Non-cardial location, heterogeneous enhancement, presence of necrosis, larger lesion size, and absence of lymphadenopathy are highly suggestive CT findings for large GISTs in differentiation from schwannomas or leiomyomas. Regardless of radiologists' expertise, diagnostic performance in differentiation can be significantly improved with knowledge of these CT findings.
机译:目的鉴定重要的CT表现以区分大的(≥5 cm)胃胃肠道间质瘤(GIST)与良性上皮下肿瘤,并通过了解重要的CT标准来评估放射科医生的分化表现是否得到改善。材料和方法招募了一百二十例接受CT病理证实的大(≥5 cm)GIST(n = 99),神经鞘瘤(n = 16)和平滑肌瘤(n = 5)的患者。两位放射科医生(A和B)以一致的方式回顾了他们的CT图像,以了解增强的位置,大小,程度和模式,轮廓,生长模式以及是否存在钙化,坏死,表面溃疡或淋巴结肿大。使用单变量和多变量统计分析确定被认为对分化具有重要意义的CT表现。此后,由另外两名具有2年和9年不同专业知识的审阅者(C和D)使用5分置信度量表分别连续进行了两次连续的GIST与非GIST区分的审阅会议。在第一届会议上,审稿人对CT图像进行了解释,而无需了解大量的CT发现。在第二届会议上,统计分析的结果提供给了审稿人。为了评估放射科医生的表现,对接收器工作曲线(ROC)进行了成对比较。结果发现异质性增强,坏死的存在,淋巴结的缺乏和平均大小≥6cm对于区分GIST和神经鞘瘤具有重要意义(P <0.05)。非心脏位置,异质性增强和坏死的存在是平滑肌瘤的GIST的CT差异(P <0.05)。多变量分析表明,不存在扩大的LN是GIST区别于神经鞘瘤的唯一统计学上显着的变量。使用ROC获得的两个审阅者的曲线下面积分别从0.682和0.613显着增加到0.903和0.904,并且具有显着的CT发现将GIST与非GIST区别开来的信息(P <0.001)。结论非心脏位置,异质性增强,坏死的存在,更大的病灶大小以及不存在淋巴结肿大,是大型GIST在从神经鞘瘤或平滑肌瘤分化中的CT表现。不管放射科医生的专业知识如何,只要了解这些CT检查结果,就可以显着提高鉴别诊断的性能。

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