多层螺旋计算机断层扫描在胃间质瘤与胃良性息肉的鉴别诊断及胃间质瘤危险度分层评估中的应用
Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment.
作者信息
Li Xiao-Long, Han Peng-Fei, Wang Wei, Shao Li-Wei, Wang Ying-Wei
机构信息
Diagnostic Radiology Department, The First Medical Center of PLA General Hospital, Beijing 100853, China.
Pathology Department, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China.
出版信息
World J Gastrointest Oncol. 2022 Oct 15;14(10):2004-2013. doi: 10.4251/wjgo.v14.i10.2004.
BACKGROUND
The biological characteristics of gastric stromal tumors are complex, and their incidence has increased in recent years. Gastric stromal tumors (GST) have potential malignant tendencies, and the probability of transformation into malignant tumors is as high as 20%-30%.
AIM
To investigate the value of multi-slice spiral computed tomography (MSCT) in the differential diagnosis of GST and benign gastric polyps, and GST risk stratification assessment.
METHODS
We included 64 patients with GST (GST group) and 60 with benign gastric polyps (control group), confirmed by pathological examination after surgery in PLA General Hospital, from January 2016 to June 2021. The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared. According to the National Institutes of Health's standard, GST is divided into low- and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values.
RESULTS
The incidences of extraluminal growth, blurred boundaries, and ulceration in the GST group were significantly higher than those in the control group ( < 0.05). The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group ( < 0.05). The MSCT differential diagnosis of GST and gastric polyp sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and areas under the curve (AUCs) were 73.44 %, 83.33%, 26.56%, 16.67%, 0.784, respectively. The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value, with a statistical difference. The results showed that the sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%, 62.20%, 19.82%, 37.80%, and 0.710, respectively. The sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%, 60.40%, 32.37%, 39.60%, and 0.710, respectively. The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group ( < 0.05). The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group ( < 0.05).
CONCLUSION
Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.
背景
胃间质瘤的生物学特性复杂，近年来其发病率有所上升。胃间质瘤（GST）具有潜在恶性倾向，转变为恶性肿瘤的概率高达20%-30%。
目的
探讨多层螺旋CT（MSCT）在胃间质瘤与胃良性息肉鉴别诊断及胃间质瘤风险分层评估中的价值。
方法
纳入2016年1月至2021年6月在解放军总医院手术后经病理检查确诊的64例胃间质瘤患者（胃间质瘤组）和60例胃良性息肉患者（对照组）。比较两组术前MSCT成像特征参数及CT增强值的差异。根据美国国立卫生研究院标准，依据MSCT成像特征参数及CT增强值将胃间质瘤分为低危组和高危组。
结果
胃间质瘤组腔外生长、边界模糊及溃疡的发生率显著高于对照组（<0.05）。胃间质瘤组动脉期CT值及CT增强峰值高于对照组（<0.05）。MSCT对胃间质瘤与胃息肉的鉴别诊断敏感度、特异度、误诊率、漏诊率及曲线下面积（AUC）分别为73.44%、83.33%、26.56%、16.67%、0.784。以动脉期CT值及CT增强峰值绘制受试者工作特征曲线，差异有统计学意义。结果显示，动脉期CT在胃间质瘤与胃息肉鉴别诊断中的敏感度、特异度、误诊率、漏诊率及AUC值分别为80.18%、62.20%、19.82%、37.80%、0.710。CT增强峰值在胃间质瘤与胃息肉鉴别诊断中的敏感度、特异度、误诊率、漏诊率及AUC值分别为67.63%、60.40%、32.37%、39.60%、0.710。高危组病变边界模糊及溃疡的发生率显著高于低危组（<0.05）。高危组动脉期及CT增强峰值显著高于低危组（<0.05）。
结论
术前MSCT检查在胃间质瘤与胃良性息肉鉴别诊断中具有重要价值，能有效评估胃间质瘤患者的风险等级。
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