Wang J, Xu J L, Hu H J
Department of Medical Imaging, Jianggan District People's Hospital, Hangzhou 310016, China.
Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University, Hangzhou 310020, China.
Zhonghua Zhong Liu Za Zhi. 2017 Mar 23;39(3):184-189. doi: 10.3760/cma.j.issn.0253-3766.2017.03.005.
To evaluate the correlation between computed tomography (CT) features and malignancy risk category of small (≤5 cm) gastric stromal tumors (GST), in order to provide an image reference for preoperative assessment and intraoperative pathological diagnosis. Eighty-three patients with surgically and pathologically proven GST (≤5 cm) between January 2011 and November 2015 were recruited, and their clinical, pathological and CT data were retrospectively analyzed. According to the pathological results and malignancy risk category, the patients were divided into 2 groups, the benign biological behavior group (very low and low risk) and malignant biological behavior group (intermediate and high risk). The clinical, pathological and CT imaging findings of the two groups were analyzed. Based on the tumor diameter, the receiver operating characteristic curve (ROC) was applied to evaluate the sensitivity, specificity and the best cut-off point for distinguishing the malignancy risk between the two groups. The lobulation and ulceration of the tumors presented statistically significant difference for the malignancy risk between the two groups ((2)=6.273 and 4.163, respectively; all <0.05), but there was no significant difference in the sex, clinical symptoms, serum ferritin, tumor site, growth pattern, cystis degeneration and calcification (all >0.05). No statistically significant differences were detected for the tumor CT value, arterial CT value, venous CT value, degrees of enhancement in arterial phase (DEAP), enhancement in portal venous phase (DEPP), and patient's age for distinguishing the malignancy risk between the two groups (all >0.05). On the other hand, significant differences were found in the maximum diameter (Dmax) of tumor and the minimum diameter (Dmin) of tumor (=-3.256 and -3.466, respectively; all <0.05). When the cut-off point of Dmax was 1.6 cm, the area under the ROC curve, sensitivity and specificity were 0.704, 92.3% and 75.4%, respectively. When the cut-off point of Dmin was 1.5 cm, the area under the ROC curve, sensitivity and specificity were 0.713, 88.5% and 71.9%, respectively. CT features of the GST (≤5 cm) may predict, before surgery, the malignancy risk of small gastric stromal tumors, and provide the an image reference for preoperative assessment and intraoperative pathological diagnosis of the disease.
为评估计算机断层扫描（CT）特征与小（≤5 cm）胃间质瘤（GST）恶性风险分类之间的相关性，以便为术前评估和术中病理诊断提供影像参考。招募了2011年1月至2015年11月期间83例经手术及病理证实为GST（≤5 cm）的患者，并对其临床、病理及CT数据进行回顾性分析。根据病理结果及恶性风险分类，将患者分为2组，即良性生物学行为组（极低和低风险）和恶性生物学行为组（中、高风险）。分析两组的临床、病理及CT影像学表现。基于肿瘤直径，应用受试者操作特征曲线（ROC）评估区分两组恶性风险的敏感性、特异性及最佳截断点。肿瘤的分叶和溃疡在两组恶性风险之间存在统计学显著差异（分别为χ²=6.273和4.163；均P<0.05），但在性别、临床症状、血清铁蛋白、肿瘤部位、生长方式、囊变及钙化方面无显著差异（均P>0.05）。在区分两组恶性风险时，肿瘤CT值、动脉期CT值、静脉期CT值、动脉期强化程度（DEAP）、门静脉期强化（DEPP）及患者年龄均未检测到统计学显著差异（均P>0.05）。另一方面，肿瘤的最大直径（Dmax）和最小直径（Dmin）存在显著差异（分别为t=-3.256和-3.466；均P<0.05）。当Dmax的截断点为1.6 cm时，ROC曲线下面积、敏感性和特异性分别为0.704、92.3%和75.4%。当Dmin的截断点为1.5 cm时，ROC曲线下面积、敏感性和特异性分别为0.713、88.5%和71.9%。≤5 cm的GST的CT特征可在术前预测小胃间质瘤的恶性风险，并为该疾病的术前评估和术中病理诊断提供影像参考。
