| Objective:Because GIST has malignant potential,and the GIST treatment strategies of different risk levels are different.Therefore,earlier detection,earlier treatment,and relatively more accurate preoperative assessment of the risk of GIST can provide patients with greater benefits.At present,there is no consensus on the first-choice auxiliary examination that can be non-invasive and in vivo to assess the risk of GIST before surgery.This article aims to analyze the value of using enhanced computed tomography(CT)and endoscopic ultrasonography(EUS)in preoperative risk assessment and diagnosis of GIST.Methods:A total of 131 cases of gastrointestinal GIST diagnosed in the pathology report of the Second Hospital of Lanzhou University from November 1,2014 to December 1,2020 were included,strictly according to the screening criteria of inclusion and exclusion.The clinical data were retrospectively analyzed,and the features of enhanced CT and EUS images and related parameters were statistically analyzed.The final pathological results were used as the gold standard for diagnosis,and the subjects were divided into groups with different risk and mitotic image counts.The correlation between different risk grades and mitotic image counts and the features of enhanced CT and EUS images was analyzed.To compare the sensitivity of enhanced CT and EUS in diagnosing GIST,as well as the sensitivity of using the two together to diagnose GIST.Results:1.The case data showed that there was no significant difference in terms of gender(male to female ratio was 0.96:1)for the incidence of GIST,The average age of onset was(55.2±11.2)years.The GIST of digestive tract was dominated by gastric GIST 87.0%(114/131),while non-gastric GIST was rare 13.0%(17/131).For common clinical manifestations,the abdominal pain was 58.0%(76/131)and abdominal distension included 42.0%(55/131),was the most one,the gastrointestinal bleeding included 28.2%(37/131),was the second one.2.According to the image from Enhanced CT,the average diameter of GIST was(42±26.0)mm,the tumor shape mostly included 67.2%(88/131),the growth mode that was dominated by cavity type included 61.1%(80/131),the uniform density of lesions included 50.4%(66/131)or the uneven included 49.6%(65/131),the 79.4% of tumor boundary was clear(104/131),a part of the tumors was coalescent and ulcer,which was counted as 32.1%(42/131),the statistical data of pulmonary vessels was42.0%(55/131),and the statistical data of calcification was 9.2%(12/131).Univariate analysis showed that the higher the risk level of GIST was,the larger the tumor diameter was,the more uneven the density was,and the more irregular the shape looked like in enhanced CT examination,and the main growth pattern of which,was outward growth type or mixed type,the less clear the tumor boundary looked like,and the more common the ulcer and the vascular shadow was in the tumor(P<0.05).According to multivariate analysis,whether tumor density was uniform and maximum transverse diameter were independent factor of predicting GIST risk(P<0.05).Tumor density uniformity,morphology,tumor boundary,growth pattern,and presence or absence of ulceration were associated with mitotic count(P<0.05),but none of these factors were independent risk factors affecting mitotic image count..3.EUS imaging showed that the average diameter of GIST tumor was(30.4±17.9)mm,the 65.0% of tumor’s shape was regular(67/103),the 84.3% of tumor had clear boundary(86/102),the statistical data of tumor originated in the muscularis propria was 84.3%(85/103),the 99.0% of tumor showed low echo(102/103),the 46.6.0% of tumor had uniform internal echo(48/103),and the 53.4% was uneven(55/103).the64.1% of tumor had smooth surface(66/103),the statistical data of tumor of GIST with calcification was 17.6%(18/102),Cystic changes included 28.4%(29/102),local invasion included 26.5%(27/102)and rupture signs included 43.1%(44/102).Univariate analysis showed that GIST risk grade was correlated with tumor diameter,morphology,smooth surface,clear boundary,local invasion and fracture signs,internal echo uniformity,calcification and cystic changes in EUS images(P<0.05);Multivariate ordered logistic regression analysis showed that tumor diameter was the only independent predictor of GIST risk(P<0.05).Tumor surface smoothness,calcification and local invasion were correlated with the mitotic count(P<0.05),but these were not independent risk factors.4.The diagnostic sensitivity of enhanced CT,EUS and combination of the two for GIST were 63.50%(66/104),85.60%(89/104)and 92.30%(96/104)respectively.The diagnostic sensitivity of EUS was better than that of enhanced CT(P<0.05),the combined diagnosis sensitivity was higher than that of enhanced CT alone(P<0.05),but there was no statistically significant difference in the sensitivity of GIST diagnosis between EUS and the combination of the two(P>0.05).Conclusion:The results showed that the image features of GIST with different risk grades were different in enhanced CT and EUS.Some of the image features could be used as indicators to judge the level of tumor risk and mitotic image count.The uniformity of tumor density and the maximum transverse diameter in enhanced CT were independent factors to predict tumor risk.The diagnostic sensitivity of GIST by EUS and EUS combined with enhanced CT was higher than that by enhanced CT alone. |
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