医学影像病例讨论课件

鉴别诊断
1 胃间质瘤
• 坏死多见，强化不均匀，具有沿胃壁的垂 直方向生长、瘤体较大但附着点较局限的 特点
• 好发于胃体、胃底，只有约14%发生于贲门， 而位于贲门者只有37%累及EGJ
高剑波,杨学华,孙勇,等.胃间质瘤表现[J].中华放射学杂志,2008,42(12):1283-1286. Yang HK, Kim YH, Lee YJ, et al. Leiomyomas in the gastric cardia: CT findings and differentiation from gastrointestinal stromal tumors.[J]. Eur J Radiol. 2015 Sep;84(9):1694-700.
胃间质瘤
Kang HC, Menias CO, Gaballah AH, et al. Beyond the GIST: mesenchymal tumors of the stomach.[J].Radiographics. 2013 Oct;33(6):1673-90.
2 胃神经鞘瘤
• 好发于胃体，呈腔内或腔内外生长，增强 扫描呈延迟强化
3 胃神经内分泌肿瘤
• 胃壁息肉样小结节或胃壁增厚伴/不伴软组 织肿块，常多发
• 增强扫描明显强化
• 常出现远处转移
柴亚如, 高剑波, 梁盼. 胃神经内分泌肿瘤的CT表现与临床病理特征[J]. 中华临床医师杂志:电子版, 2015(13):140-143. Levy AD, Sobin LH.From the archives of the AFIP: Gastrointestinal carcinoids: imaging features with clinicopathologic comparison.Radiographics. 2007 Jan-Feb;27(1):237-57.
胃平滑肌瘤的影像学特点：
① 累及EGJ
② 密度及强化均匀，无坏死、钙化
③ 轻度强化（与背部肌肉相比）
④ 长径/短径＞1.2（轴位测量）
Lee MJ, Lim JS, Kwon JE, et al. Gastric true leiomyoma: computed tomographic findings and pathological correlation.[J]. J Comput Assist Tomogr. 2007 Mar-Apr;31(2):204-8. Zhu H, Chen H, Zhang S, et al. Differentiation of gastric true leiomyoma from gastric stromal tumor based on biphasic contrast-enhanced computed tomographic findings.[J]. J Comput Assist Tomogr. 2014 Mar-Apr;38(2):228-34.
• 瘤体可以上到很大，但很少坏死 • 周围脂肪间隙内可见到肿大淋巴结，虽然
敏感度低，但特异度较高
Kang HC, Menias CO, Gaballah AH, et al. Beyond the GIST: mesenchymal tumors of the stomach.[J].Radiographics. 2013 Oct;33(6):1673-90. Choi JW, Choi D, Kim KM,et al. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT.[J]. Korean J Radiol,2012,13(4):425-33. 陈岩, 梁盼, 高歌,等. 多排螺旋CT对胃小间质瘤与胃小神经鞘瘤的鉴别诊断价值[J]. 实用放射学杂志, 2014, 30(9).
胃平滑肌瘤
Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma.[J]. Radiology. 2009 Jul;252(1):92-100. Kang HC, Menias CO, Gaballah AH, et al. Beyond the GIST: mesenchymal tumors of the stomach.[J].Radiographics. 2013 Oct;33(6):1673-90.
患者女，50岁，反复呃逆2月，余无特殊
动脉期
门脉期
平衡期
请选择
① 神经鞘瘤 ② 平滑肌瘤 ③ 间质瘤 ④ 神经内分泌肿瘤 ⑤ 异位胰腺
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小结 病理结果：平滑肌瘤
贲门部软组织影，边界清楚，密度均匀， 增强扫描强化程度较背部肌肉略低，瘤体累 及胃食管连接部（esophagogastric junction EGJ)，与胃壁呈宽基底相连，向腔 内生长。
胃神经鞘瘤
Choi JW, Choi D, Kim KM,et al. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT.[J]. Korean J Radiol,2012,13(4):425-33.
诊断：胃平滑肌瘤
消化道平滑肌瘤好发于食管，真正发生于胃的 平滑肌瘤相对少见。直径小于1cm的胃平滑肌瘤多 于胃镜或手术中无意发现，可以发生于胃的任何位 置，但直径大于1cm的胃平滑肌瘤主要发生于贲门， 且累及EGJ。
Kang HC, Menias CO, Gaballah AH, et al. Beyond the GIST: mesenchymal tumors of the stomach.[J].Radiographics. 2013 Oct;33(6):1673-90. Yang HK, Kim YH, Lee YJ, et al. Leiomyomas in the gastric cardia: CT findings and differentiation from gastrointestinal stromal tumors.[J]. Eur J Radiol. 2015 Sep;84(9):1694-700.
胃神经内分泌肿瘤
Levy AD, Sobin LH.From the archives of the AFIP: Gastrointestinal carcinoids:imaging features with clinicopathologic comparison.Radiographics. 2007 Jan-Feb;27(1):237-57.
胃异位胰腺
Kim JY, Lee JM, Kim KW,et al.Ectopic Pancreas: CT Findings with Emphasis on Differentiation From Small Gastrointestinal Stromal Tumor and Leiomyoma[J]. Radiology, 2009, 252(1):92-100.
Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma.[J]. Radiology. 2009 Jul;252(1):92-100. Yang HK, Kim YH, Lee YJ, et al. Leiomyomas in the gastric cardia: CT findings and differentiation from gastrointestinal stromal tumors.[J]. Eur J Radiol. 2015 Sep;84(9):1694700.
4 胃异位胰腺
• 好发于胃窦 • 腔内生长 • 边界不清楚 • 瘤体粘膜面明显强化 • 长径/短径＞1.4
郭宁,张劲松,袁怀平,等.胃部异位胰腺MSCT表现[J].实用放射学杂志,2014,30(9):58-61. Kim JY, Lee JM, Kim KW,et al.Ectopic Pancreas: CT Findings with Emphasis on Differentiation From Small Gastrointestinal Stromal Tumor and Leiomyoma[J]. Radiology, 2009, 252(1):92-100.