Chun H J, Byun J Y, Chun K A, Rha S E, Jung S E, Lee J M, Shinn K S
Department of Radiology, Catholic University Medical College, Kangnam St. Mary's Hospital, Seoul, Korea.
J Comput Assist Tomogr. 1998 Jan-Feb;22(1):69-74. doi: 10.1097/00004728-199801000-00012.
Our goal was to evaluate CT efficacy in differentiating gastrointestinal leiomyoma and leiomyosarcoma.
We retrospectively reviewed CT scans of 45 patients (21 men, 24 women, mean age 55 years) with surgically proven gastrointestinal leiomyomas (n = 21) and leiomyosarcomas (n = 24) with respect to size, contour, enhancing pattern, mesenteric fat infiltration, calcification, ulceration, regional lymphadenopathy, direct invasion, distant metastasis, and growth pattern after visual inspection by two radiologists in agreement. On the basis of these CT features, subjective diagnosis was also categorized into three groups (Group I: probably benign, Group II: probably malignant, Group III: diagnostic malignant). The results were compared with the final histopathologic diagnosis.
In addition to the features of direct invasion and distant metastasis suggesting diagnostic malignancy, the CT features favoring malignancy with statistical significance included larger size (> 5 cm), lobulated contour, heterogeneous enhancement, mesenteric fat infiltration, ulceration, regional lymphadenopathy, and exophytic growth pattern (p < 0.005). However, calcification was not significant in differentiating the two entities (p = 0.25163). A subjective analysis revealed 89% sensitivity, 85% specificity, and 87% accuracy for diagnosis of leiomyosarcoma.
CT features are useful in differentiating leiomyoma and leiomyosarcoma in gastrointestinal tract.
我们的目标是评估CT在鉴别胃肠道平滑肌瘤和平滑肌肉瘤方面的有效性。
我们回顾性分析了45例患者（21例男性，24例女性，平均年龄55岁）的CT扫描结果，这些患者经手术证实患有胃肠道平滑肌瘤（n = 21）和平滑肌肉瘤（n = 24）。由两位放射科医生共同观察，评估肿瘤的大小、轮廓、强化方式、肠系膜脂肪浸润、钙化、溃疡、区域淋巴结肿大、直接侵犯、远处转移及生长方式。基于这些CT特征，主观诊断也分为三组（I组：可能为良性；II组：可能为恶性；III组：诊断为恶性）。将结果与最终的组织病理学诊断进行比较。
除了提示诊断为恶性的直接侵犯和远处转移特征外，具有统计学意义的支持恶性的CT特征包括更大的尺寸（> 5 cm）、分叶状轮廓、不均匀强化、肠系膜脂肪浸润、溃疡、区域淋巴结肿大及外生性生长方式（p < 0.005）。然而，钙化在鉴别这两种病变时无统计学意义（p = 0.25163）。主观分析显示，诊断平滑肌肉瘤的敏感性为89%，特异性为85%，准确性为87%。
CT特征有助于鉴别胃肠道平滑肌瘤和平滑肌肉瘤。
