Computed tomography features and predictive findings of ruptured gastrointestinal stromal tumours
Computed tomography features and predictive findings of ruptured gastrointestinal stromal tumours
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DOI：
10.1007/s00330-016-4515-z
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发表时间：
2017-06-01
影响因子：
5.9
通讯作者：
Ha, Hyun Kwon
中科院分区：
文献类型：
--
作者：
Kim, Jin Sil;Kim, Hyun Jin;Ha, Hyun Kwon
目的通过与破裂前CT及未破裂GIST CT的比较，探讨破裂GIST的CT表现及可能的破裂因素。回顾了包括药物治疗在内的临床资料。分析其影像学表现。结果GIST破裂部位以小肠最多见，平均12.1cm。GIST破裂多表现为肠壁缺损、> 40%偏心性坏死、分叶状、空气密度团块、气腹、腹膜炎、腹腔积血和腹水（p < 0.001-0.030）. 30例随访影像学检查的患者中，27例接受了靶向治疗。在随访期间，肿瘤壁的厚度下降。靶向治疗时肿瘤体积增大、坏死进展较常见（p = 0.017），新发腹水、腹膜炎、腹腔积血较常见（p < 0.001-0.036）。在靶向治疗期间，坏死的进展伴随着尺寸的增加和壁厚度的减少可能增加破裂的风险。如果在随访期间发现新发腹膜炎、腹腔积血或腹水，则应考虑破裂。
Objectives To evaluate the CT features of ruptured GISTs and factors that might be predictive of rupture through comparison with CTs taken prior to rupture and CTs of non-ruptured GIST.Methods Forty-nine patients with ruptured GIST and fortynine patients with non-ruptured GIST matched by age, gender and location were included. Clinical data including pharmacotherapy were reviewed. The imaging features were analyzed. Prior CT obtained before rupture were evaluated.Results The most common location of ruptured GIST was small bowel with mean size of 12.1 cm. Ruptured GIST commonly showed wall defects, >40 % eccentric necrosis, lobulated shaped, air density in mass, pneumoperitoneum, peritonitis, hemoperitoneum and ascites (p < 0.001-0.030). Twenty-seven of 30 patients with follow up imaging received targeted therapy. During follow-up, thickness of the tumour wall decreased. Increase in size and progression of necrosis were common during targeted therapy (p = 0.017).Newly developed ascites, peritonitis and hemoperitoneum was more common (p < 0.001-0.036).Conclusion Ruptured GISTs commonly demonstrate large size, >40 % eccentric necrosis, wall defects and lobulated shape. The progression of necrosis with increase in size and decreased wall thickness during targeted therapy may increase the risk of rupture. Rupture should be considered when newly developed peritonitis, hemoperitoneum, or ascites are noted during the follow-up.