术前 CT 显示不完全覆盖的增强黏膜特征是胃胃肠间质瘤的高危预测因素。
Preoperative CT feature of incomplete overlying enhancing mucosa as a high-risk predictor in gastrointestinal stromal tumors of the stomach.
机构信息
Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China.
Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China.
出版信息
Eur Radiol. 2021 May;31(5):3276-3285. doi: 10.1007/s00330-020-07377-5. Epub 2020 Oct 30.
OBJECTIVES
To determine whether the CT finding of overlying enhancing gastric mucosa (OEGM) can be used to predict risk stratifications by observing CT features of gastrointestinal stromal tumors (GISTs) of the stomach.
METHODS
Clinical characteristics and CT features within pathologically demonstrated GISTs were retrospectively reviewed. Risk stratifications were classified into non-high group and high-risk group according to the modified National Institutes of Health criteria. Univariate analysis and multivariate logistic regression analysis were performed in order to determine significant predictors for high-risk stratification. Receiver operating characteristic (ROC) curve analysis, subgroup analysis, and pathologic-radiologic correlation analysis were all executed.
RESULTS
A total of 147 patients were finally enrolled as test subjects. Within the univariate analysis, high-risk tumors tended to have a larger diameter, irregular shape, exophytic growth pattern, present necrosis, incomplete OEGM, tumor vessels, heterogeneous enhancement, and present rupture. According to ROC curve analysis, incomplete OEGM showed the largest area under curve values for diagnosing lesions (0.835; 95% CI, 0.766-0.904; p < 0.001). Multivariate analysis showed that the incomplete OEGM was the strongest independent predictor for high-risk stratification of gastric GISTs (OR = 21.944; 95% CI, 4.344-110.863; p < 0.001). Within the subgroup analysis, incomplete OEGM was more frequently associated with tumors size > 10 cm, irregular shape, exophytic growth pattern, high mitotic count, and disrupted mucosa on pathology.
CONCLUSIONS
The CT feature of incomplete OEGM is an independent predictive factor for high-risk stratification of gastric GISTs and strongly correlated with pathological mucosal changes.
KEY POINTS
• Preoperative CT features can be helpful in assessment of risk stratifications of gastric GISTs. • OEGM is an independent predictor for high-risk stratification of gastric GISTs. • Incomplete OEGM likely indicates high-risk stratification of gastric GISTs.
目的
通过观察胃间质瘤（GIST）的 CT 特征，确定胃 GIST 中覆盖增强的胃黏膜（OEGM）的 CT 表现是否可用于预测风险分层。
方法
回顾性分析经病理证实的 GIST 的临床特征和 CT 特征。根据改良的美国国立卫生研究院标准，将风险分层分为非高危组和高危组。进行单因素分析和多因素逻辑回归分析，以确定高危分层的显著预测因子。进行了受试者工作特征（ROC）曲线分析、亚组分析和病理-放射学相关性分析。
结果
共有 147 例患者最终被纳入研究对象。单因素分析中，高危肿瘤倾向于具有更大的直径、不规则的形状、外生性生长模式、存在坏死、不完整的 OEGM、肿瘤血管、不均匀增强和存在破裂。根据 ROC 曲线分析，不完整的 OEGM 对诊断病变具有最大的曲线下面积值（0.835；95%CI，0.766-0.904；p<0.001）。多因素分析显示，不完整的 OEGM 是胃 GIST 高危分层的最强独立预测因子（OR=21.944；95%CI，4.344-110.863；p<0.001）。在亚组分析中，不完整的 OEGM 更常与肿瘤大小>10cm、不规则形状、外生性生长模式、高有丝分裂计数和病理上的黏膜破坏有关。
结论
CT 表现不完整的 OEGM 是胃 GIST 高危分层的独立预测因素，与病理黏膜变化密切相关。
关键点
术前 CT 特征有助于评估胃 GIST 的风险分层。
OEGM 是胃 GIST 高危分层的独立预测因子。
不完整的 OEGM 可能提示胃 GIST 为高危分层。
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