摘要
目的探讨CT在(≤5 cm)胃间质瘤(GIST)和胃神经鞘瘤(GS)鉴别中的应用价值。方法回顾性分析(≤5 cm)GIST(n=65)和GS(n=15)的CT表现,所有患者均经手术病理证实。由两位放射科医师对CT影像进行独立评估并达成一致意见,内容包括大小、位置、形态、生长方式、强化方式、强化程度、囊变、钙化、溃疡、淋巴结,并对患者的临床资料进行分析。两组间的分类变量采用χ~2检验或费歇尔精确检验。两组间连续变量采用独立样本t检验。采用ROC曲线分析肿瘤CT测量与计算值对鉴别GIST和GS的最佳临界值、敏感性和特异性。结果GIST和GS组的肿瘤大小、生长方式、钙化、溃疡、患者的年龄以及临床症状差异均无统计学意义(P值均>0.05)。两组患者的性别和肿瘤指标(Fe蛋白)差异有统计学意义(χ~2值分别为4.600和4.232,P值均<0.05)。CT检查,两组肿瘤的形态、位置、强化方式和静脉期增强幅度(DE3)的差异均有统计学意义(χ~2=4.890、9.883、6.443,t=-2.561,P值均<0.05)。ROC曲线分析显示静脉期CT值、动脉期增强幅度(DE1)、静脉期较动脉期增强幅度(DE2)、DE3鉴别GS和GIST的曲线下面积、截断点、敏感性、特异性分别为0.632、57.9 HU、100%(15/15)、68.2%(45/66);0.636、11.3 HU、93.3%(14/15)、74.2%(49/66);0.611、5.15 HU、93.3%(14/15)、77.3%(51/65);0.674、27.7 HU、100%(15/15)、62.1%(41/66)。结论 CT检查结合患者临床资料对(≤5 cm)GIST和GS的鉴别中:分叶、不均匀强化及肿瘤指标Fe蛋白含量异常,有利于GIST的诊断;女性、肿瘤位于胃体大弯侧、均匀渐进性强化及静脉期CT值、DE1、DE2、DE3值分别大于57.9 HU、11.3 HU、5.15 HU、27.7 HU有利于GS的诊断。
Objective To discuss the differentiation of（ ≤5 cm） gastrointestinal stromal tumor（ GIST） and gastric schwannoma（ GS） ： applied value of CT. Methods All patients underwent surgery and pathology proven（ ≤5 cm） GIST（ n = 65） and GS（ n = 15） whose CT images were retrospectively analysed. Two radiologists retrospectively reviewed the CT images evaluating the size,location,contour,growth pattern,degree and pattern of enhancement,calcification,necrosis,surface ulceration,lymph nodes,and the clinical date of patient analysis. The chi-square or Fisher’s exact test was used for discrete variables and the independent sample T test for continuous variables. Receiver operating characteristic（ ROC） curves were employed to assess the measurement and calculation of parameters in the differentiation of GIST from GS. Results Between GIST and GS groups,there was no statistical significant difference in the size,growth pattern,calcification,necrosis,surface ulceration,patient’s age and clinical symptoms（ P 〉 0. 05）,and there were differences in sex and tumor marker（ Ferritin）（ χ~2= 4. 600 and 4. 23,P 〈 0. 05）. Contour,location,pattern of enhancement,degree of on enhancement in portal venous phase（ DE3） were found to be differentiating GIST and GS on CT examination（ χ~2=4. 890、9. 883、6. 443,t =- 2. 561,P 〈 0. 05）. When the cutoff values were 57. 9 HU,11. 3 HU,5. 15 HU,27. 7 HU,the sensitivity and specificity of the CT values in portal venous phase,degree of enhancement in arterial phase（ DE1） and in portal venous phase more than arterial phase（ DE2）,DE3 to differentiate GIST and GS were 100%（ 15 /15） 、93. 3%（ 14 /15）,93. 3%（ 14 /15）,100%（ 15 /15） and 68. 2%（ 45 /66）,74. 2%（ 49 /66）,77. 3%（ 51 /66） and 62. 1%（ 41 /66）,respectively. The corresponding areas under the ROC curve were 0. 632,0. 636,0. 611,0. 674. Conclusion For the differentiation of（ ≤5 cm） GIST and GS： lobulated,heterogeneous enhancement and abnormal F
作者
王健
徐军良
厉锋
胡红杰
WANG Jian XU Junliang LI Feng et al.(Department of Medical Imaging,Jianggan District People＇s Hospital, Hangzhou, Zhejiang Province 310020, P. R. China)
出处
《临床放射学杂志》
CSCD
北大核心
2017年第2期236-241,共6页
Journal of Clinical Radiology
关键词
胃肿瘤
鉴别诊断
体层摄影术
X线计算机
Gastric neoplasm
Differential diagnosis
Tomography,X-ray computed
