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The Comparative Analysis of Multislice Spiral CT Findings and Malignancy Grade in Gastrointestinal Stromal Tumors

Author: ChangRuiPing
Tutor: ChengJingLiang
School: Zhengzhou University
Course: Medical Imaging and Nuclear Medicine
Keywords: Gastrointestinal tract Stromal tumors MSCT Risk classification
CLC: R735
Type: Master's thesis
Year: 2010
Downloads: 21
Quote: 0
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Abstract


The background and purpose of gastrointestinal stromal tumor (gastrointestinal stromal tumor, GIST) is the most common gastrointestinal mesenchymal tumors, is the largest species of the gastrointestinal tract with primary epithelial tumors. Was first proposed in 1983 by Mazur and Clack, 1998, kindblom found GIST expression of C-kit gene product, and then speculate related to the occurrence of C-kit gene GIST, which really GIST and other gastrointestinal mesenchymal source tumors distinguish. GIST is defined as: occurred in the full length of the gastrointestinal tract, part of the wealth to the spindle cell found in the abdominal cavity, histology, epithelioid cells, occasionally pleomorphic cells was bundle diffuse-like arrangement, the immune phenotype expression of C-kit gene protein product, the most common mesenchymal tumors by mesenchymal cells differentiation to the ICC. Previous studies that, GIST to conventional chemotherapy and radiotherapy is not sensitive, but With GIST molecular biology research progress, GIST molecular targeted therapy is considered an effective way of treatment. The study accurately determine GIST benign or malignant, and the degree of malignancy, more important significance for guiding clinical treatment, but how to determine the biological behavior of GIST is still the focus of current research and the difficulty. With the in-depth study of the pathology sector in this regard, MSCT, because of its excellent density resolution, in the judgment of the GIST biological behavior, structural characteristics and morphological properties of advantages more and more significant. The purpose of this study is to investigate the MSCT diagnosis of GIST, the judge of the value of the differential diagnosis and its degree of malignancy. So as to further improve the diagnosis of gastrointestinal stromal tumors, help their preoperative diagnosis and prognosis. Materials and methods to collect the Chinese People's Liberation Army General Hospital in May 2008 - August primary gastrointestinal stromal tumors of 45 patients, 21 males and 24 females, with a median age of 55 years old. Multiple two cases, the single 43 cases; clinical manifestations of black stools (24.4%), abdominal pain (20%) (13.3%), abdominal discomfort, abdominal mass (17.7%), asymptomatic (24.4%). In all cases by surgery and pathology and immunohistochemistry diagnosed, of which 24 cases of high-risk cases, nine cases of risk, and low risk in 13 cases, a very low-risk patients. This group, the patients only chest unenhanced check, 2 patients with pelvic examination only line single-phase scan. 42 patients received a CT scan and dual-phase enhanced scan. The first plain and then enhanced enhanced scan using high-pressure syringe 3.5ml / s flow rate of injection of contrast medium iohexol (300mgI/ml) 90ml line double scan, dual-phase enhanced molecular injection after the start of 25-30s (arterial phase) ,65-70s (portal phase) scan, slice thickness 5mm; plain and enhanced scan slice thickness of 1.5mm layer pitch 1.5mm standard reconstruction. Combined with the clinical manifestations of the disease, the pathological findings of MSCT findings were retrospectively analyzed and summarized. Using SPSS13.0 for statistical analysis. Tumor clinical classification as the dependent variable and the various CT characteristics as independent variables, univariate and multivariate analysis. Univariate analysis using chi-square test, and multivariate analysis using multiple logistic regression. The inspection level α = 0.05. Results ① stomach in 18 patients (40%), small intestine 16 cases (35.5%, duodenum six cases, five cases of the ileum, jejunum 5 cases), colon in 5 cases (11.1%), retroperitoneal in 5 cases (11.1%), The chest one cases (2.2%). The ② cavity growth 7 cases the chamber internal and external growth of 11 cases, 21 cases of extraluminal growth, retroperitoneal five cases of pleural one cases. ③ the tumor diameter gt; 5 cm 26 lesions with a diameter ≤ 5 cm 21 lesions. ④ 22 Rules lesion morphology was round or oval, the 25 foci irregular or lobulated. Plain 26 lesions were solid density is relatively uniform, clear boundary; hemorrhagic cystic areas of necrosis were seen in 21 lesions. 4 See, for example, ulcers and gastrointestinal lumen. ⑤ enhanced 44 lesions, uniform solid strengthen the 16 cases was uniform density contrast enhancement, border and clear; uneven solid enhancement in 6 cases. The four cases were class orange petal-like enhancement. Uniform thick-walled ring enhancement, the uneven ring enhancement 11 cases. Irregular enhancement in 5 cases. ⑥ Transfer: recurrence or metastasis 10 cases, which liver metastases eight cases, the peritoneal metastases seven cases, spleen metastasis in 3 cases, adrenal metastasis in 2 cases. ⑦ single factor statistical results show the different size of the tumor, whether the tumor cystic bleeding calcified tumor and different way of strengthening clinical grading difference was statistically significant (P lt; 0.05), while the incidence of tumor location, shape growth pattern and degree of enhancement and tumor clinical classification is not statistically significant. Of multiple classifiers logistic regression analysis results in the high-risk group as the reference category under the conditions for low group, tumor size, enhancement pattern and cystic bleeding calcification can affect the clinical classification of tumors, while the change in the risk group, tumor size and capsule bleeding calcification can affect the clinical grade of the tumor. Conclusion ① gastrointestinal stromal tumors predilection in the stomach, followed by the small intestine. Stomach and colon tumor growth mainly outside the cavity (61.2% and 83.3%), small bowel tumors to the growth of the main cavity inside and outside the chamber (both 41.2%). ② cavity growth of tumor diameter ≤ 5cm uniform solid enhancement low risk of GIST tumors prompted. The the ③ extraluminal growth of tumor diameter gt; a 5cm uneven ring enhancement tumors prompted high-risk GIST. The ④ tumor abnormal enhancement of vascular shadow and more prompt high risk of GIST. ⑤ GIST mainly to blood metastasis, liver and peritoneal its main sites of metastases, few lymph node metastasis. (6) the size of the tumor, cystic hemorrhagic necrosis and enhanced with clinical grading, not related to the disease site, morphology, growth pattern and degree of enhancement with clinical grading. ⑦ MSCT can clearly show the relationship between gastrointestinal stromal tumor size, density, shape, growth pattern, and the rest of the adjacent structures to determine the initial degree of malignant potential of the tumor, distant metastasis, and clinical preoperative diagnosis and assessment noninvasive, simple, effective method to check.

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