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Manifestations of Rectal Stromal Tumor in the Endorectal Ultrasonography and Contrast-enhanced Ultrasonography
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摘要:
目的 探讨直肠间质瘤腔内超声及超声造影表现。 方法 回顾性收集2013年2月至2019年2月于中国医学科学院肿瘤医院就诊的直肠间质瘤患者的临床资料, 包括临床表现, 耦合剂充盈法腔内超声、超声造影、CT、MRI、肠镜检查结果等。按照间质瘤危险度分级将患者分为极低危、低危、中危、高危4个级别, 分析不同级别超声造影检查特点, 并比较不同检查方式诊断直肠间质瘤的准确率。 结果 共12例符合纳入和排除标准的患者入选本研究, 其中男性8例, 女性4例, 中位年龄54.0(50.5, 65.25)岁。极低/低危组6例, 中/高危组6例。肿瘤最大直径0.8~11.2 cm, 腔内超声表现为向肠腔外生长的类圆形(7例, 58.3%)或分叶状(5例, 41.7%)低回声肿块, 边界多较清晰(11例, 91.7%), 内部回声多不均匀(11例, 91.7%), 较大者可见囊变区(5例, 41.7%), 内部血流信号多较丰富(11例, 91.7%)。超声造影增强时相表现为动脉期不同程度快速显著增强[上升时间(8.10±4.03)s], 并于动脉期或静脉期达峰[达峰时间(25.54±12.16)s], 随后造影剂逐渐缓慢退出; 中/高危组5例(83.3%)患者造影剂呈不均匀分布、向心性增强, 且存在造影剂未灌注区; 而极低/低危组仅1例(16.7%)造影剂呈不均匀分布或存在造影剂未灌注区, 且6例(100%)均为弥漫性增强。与CT(60.0%)、MRI(66.7%)、肠镜(0)相比, 腔内超声联合超声造影检查(100%)对直肠间质瘤的诊断准确率更高。 结论 耦合剂充盈法腔内超声联合超声造影技术可很好地显示肿瘤起源和血管灌注情况, 有助于明确诊断直肠间质瘤, 且对直肠间质瘤的危险度分级具有提示意义。 Abstract:Objective To analyze the features of rectal stromal tumors in the endorectal ultrasonography and contrast enhanced ultrasonography (CEUS). Methods The clinical data of patients with rectal stromal tumors who were admitted in the Cancer Hospital, Chinese Academy of Medical Sciences from February 2013 to February 2019 were analyzed retrospectively, including clinical manifestations, CT, MRI, colonoscopy, rectalendorectal ultrasound, and CEUS. According to the consensus on the classification system of National Institutes of Health (NIH), the patients were divided into high-risk, intermediate-risk, low and very low-risk groups. The imaging features of different groups were compared to each other, and the accuracy of different examination methods in the diagnosis of rectal stromal tumors were analyzed. Results A total of 12 patients were included:8 males and 4 females with a median age of 54.0(50.5, 65.25)years. There were 6 cases in very low/low-risk group and 6 cases in intermediate/high-risk group. All of the tumors showed an extroluminal growth pattern, 58.3%(7/12) appearing as oval-shaped, 41.7%(5/12) as lobulated, 91.7%(11/12) with distinct borders, 91.7%(11/12) with heterogeneous echogenicity, 41.7%(5/12) of large tumors with cystic regions, and 91.7%(11/12) with abundant internal blood flow signals. The enhancing mode showed hyper-enhanced with a "fast in and slow out" pattern; the average rise time was (8.10±4.03)s; the average time to peak was (25.54±12.16)s. A total of 5 (83.3%) patients in the intermediate/high-risk group showed inhomogeneous enhancement, centripetal enhancement, perfusion defects. Only one (16.7%) patient in the very low/low-risk group showed similar CEUS feature, and all 6 (100%) patients showed diffuse enhancement. The ratio of correct diagnosis was 60.0% in CT, 66.7% in MRI, 0 in colonoscopy, and 100% in rectal endorectal ultrasound combined with CEUS. Conclusion s The combination of endorectal ultrasonography and CEUS with coupling gel filling the rectum could clearly show the original layer and distribution pattern of rectal stromal tumors, which is helpful for the diagnosis of rectal stromal tumor and accurate risk stratification of the rectal stromal tumor. -
Key words:
- stromal tumor /
- rectum /
- contrast enhanced ultrasound /
- endorectal ultrasound
利益冲突 无 -
图 1 男性，66岁，直肠间质瘤高危患者，排便困难3个月，腔内超声显示肿瘤位于肌层，最大直径10.8 cm，向腔内外生长，分叶状低回声肿物，边界清晰，回声不均匀(A)，CDFI可见丰富血流信号(B)，超声造影表现为弥漫性不均匀增强，可见粗大肿瘤血管(C，白色箭头)及造影剂未灌注区(C，黄色箭头)，明确诊断为直肠间质瘤；增强CT仅提示盆腔低密度肿物(D，蓝色箭头)，与直肠左后壁分解不清，与盆底筋膜关系密切，不均匀轻度强化，考虑为软组织肿瘤
图 2 男性，55岁，直肠间质瘤极低危患者，排便不适感1个月，腔内超声显示肿瘤位于肌层，最大直径0.6 cm，类圆形低回声肿物，边界清晰，回声不均匀(A，白色箭头)，CDFI可见较丰富血流信号(B)，明确诊断为直肠间质瘤；T1WI显示肿瘤位于直肠左侧壁(C，黄色箭头)，T2WI肿瘤位于直肠左侧壁(D，蓝色箭头)，MRI仅提示为低度恶性肿瘤
表 1 12例直肠间质瘤不同危险度患者超声造影参数比较(x±s)
组别 RT(s) TTP(s) PI(dB) MTT(s) AS AUC 极低/低危组(n=6) 7.93±4.46 26.69±15.28 7.25±3.71 25.94±10.67 .98±0.46 365.91±137.64 中/高危组(n=6) 9.29±4.04 25.78±8.64 13.28±4.16 30.74±7.26 1.33±0.61 604.09±131.00 RT：上升时间；TTP：达峰时间；PI：峰值强度；MTT：平均渡越时间；AS:上升斜率；AUC:曲线下面积 
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表 2 12例直肠间质瘤不同危险度患者超声造影模式特征比较[n(%)]
超声造影模式 极低/低危组(n=6)中 中/高危组(n=6) 造影剂分布 均匀 5(83.3) 1(16.7) 不均匀 1(16.7) 5(83.3) 未灌注区 有 0(0) 5(83.3) 无 6(100) 1(16.7) 造影剂填充方式 向心性/离心性增强 0(0) 5(83.3) 弥漫性增强 6(100) 1(16.7) 粗大不规则血管 有 2(33.3) 5(83.3) 无 4(66.7) 1(16.7)
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表 3 不同检查对12例直肠间质瘤患者的诊断结果[n(%)]
检查 明确肿瘤起源于直肠 诊断间质瘤 是 否 是 否 腔内超声联合超声造影检查(n=12) 12(100) 0(0) 12(100) 0(0) CT(n=10) 6(60.0) 4(40.0) 6(60.0) 4(40.0) MRI(n=9) 7(77.8) 2(22.2) 6(66.7) 3(33.3) 肠镜(n=5) 0(0) 5(100) 0(0) 5(100)
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