| Background and objectiveThe purpose of this study is to explore the preoperative diagnostic value of endoscopic and multislice CT combined with the comparison of lesions and pathological results.Further improve the diagnosis level of preoperative evaluation of submucosal masses,provide more detailed examination scheme for clinicians to accurately operate,and further rationalize the treatment scheme and specific treatment during operation.Materials and methods:By comparing the preoperative evaluation and display of endoscopic and multislice CT in esophageal submucosal lesions,the purpose of this study was to explore the preoperative diagnostic value of endoscopic and multislice CT combined with postoperative lesions and pathological results.Further improve the diagnosis level of preoperative evaluation of submucosal masses,provide more detailed examination scheme for clinicians to accurately operate,and further rationalize the treatment scheme and specific treatment during operation.Results: 1.A total of 58 patients,60 lesions included in the experiment,36 male patients,22 female patients,the maximum age of 69 years,the minimum age of 30 years,the average age of 51.68 years.Most of them are middle-aged(40-64),47 in total,accounting for 81.0% of the total cases.2.Leiomyoma is the most common submucosal mass in esophagus.48 cases of leiomyoma were found in 58 cases,accounting for 82.8% of the total.Among them,29 were male,19 were female,39 were middle-aged and old(40-64)patients.Other granular cell tumors were found in 2 cases(3.4%),lymphangioma in 1 case(1.7%),elastin fibroma in 1 case(1.7%),stromal tumor in 1 case(1.7%),poorly differentiated squamous cell carcinoma in 1 case(1.7%),spindle cell tumor in 2 cases(3.4%),squamous papilloma in 1 case(1.7%),squamous epithelial hyperplasia and submucous edema in 1 case(1.7%).3.In 58 cases,the origin of the tumor was consistent with the pre-operative evaluation of ultrasound.The origin of the tumor was in the muscularis mucosa in 23 cases,accounting for 39.7% of the total.The origin of the tumor was in the submucosa in 7 cases,accounting for 12.1% of the total.The origin of the tumor was in the muscularis propria in 26 cases,accounting for 44.8% of the total.The boundary of the muscularis propria propria submucosa was unclear in 1 case,accounting for 1.7% of the total.4.In 58 patients,60 lesions were found by endoscopic ultrasonography before operation,and 62 lesions were confirmed after operation.The detection rate of lesions was 96.8%.Among the 58 patients,55 had MSCT examination before operation,of which only 33 lesions were found in the images by the imaging doctors,and the rest 22 did not find submucosal masses,with the detection rate of 60%.Chi square test showed that x2 = 3.272,P > 0.05,that is,the difference between endoscopic ultrasonography and MSCT was statistically significant.5.In 55 cases of esophageal ultrasonography and MSCT,the maximum diameter of the tumor was divided into four parts according to the quartering method: the longest diameter < 5mm,the longest diameter between 5-8mm,the longest diameter between 8-13.9mm and the longest diameter > 13.9mm.Among them,there were 14 cases with the longest diameter less than 5mm,among which 4 cases(28.6%)were found by CT;14 cases with the longest diameter between 5-8mm,6 cases(42.9)were found by CT;14 cases with the longest diameter between 8-13.9mm,11 cases(78.6%)were found by CT;13 cases with the longest diameter greater than 13.9mm,12 cases(92.3%)were found by CT.Chi square test showed that C2 = 15.142,P < 0.05,that is,MSCT had statistical significance in the detection of tumors of different sizes.6.Of the 55 patients who received MSCT,15 were located in the upper esophageal segment,of which 7(46.7%)were found by CT;21 were located in the middle mucosa,14(66.7%)were found by CT;19 were located in the lower esophageal segment,of which 12(63.2%)were found by CT;chi square test showed that x2 = 1.579,P > 0.05,that is,MSCT had no statistical significance in the diagnosis of esophageal masses.7.48 cases were confirmed as leiomyoma by pathology,among which 44 cases were consistent with endoscopic ultrasonography(91.7%),4 cases were inconsistent(8.3%).Among the 10 lesions of other pathological types,only 1 case(10.0%)was consistent with the endoscopic diagnosis,and 9 cases(90.0%)were inconsistent.Chi square test showed that C2 = 24.443,P < 0.001,that is to say,endoscopic diagnosis of leiomyoma was statistically significant.The diagnostic rate of MSCT was 85.7%,slightly lower than that of EUS.8.In 33 cases detected by both methods,there was little difference between the maximum transverse diameter measured by endoscopy and MSCT.In general,the measurement values of the two methods were basically the same.After statistical analysis,t = 0.949,P = 0.345.Therefore,there was no significant difference between the two examinations in the measurement of tumor size.9.Through MSCT three-dimensional post-processing tumor segmentation,the volume of lesions was measured in 33 cases,and the length of transverse and longitudinal lesions were compared.It was found that the length of transverse lesions in 7 cases was greater than the length of longitudinal lesions,and the length of transverse lesions in the remaining 26 cases was less than the length of longitudinal lesions.The results showed that the volume of lesions was positively correlated with the length and the length of the transection.The results showed that the correlation between lesion volume and longitudinal length was stronger than that of transverse length.10.There were 48 cases of leiomyoma,accounting for 82.6% of the total pathology.The diagnosis of leiomyoma by endoscopic ultrasonography and MSCT is reliable.Endoscopic ultrasonography showed that 48 cases of leiomyomas were hypoechoic,40 cases were homogeneous,46 cases showed clear boundary,20 cases were from muscularis mucosa,4 cases were from submucosa,24 cases were from muscularis propria.Among 48 cases of leiomyoma,28 cases were observed by MSCT,including 23 cases of uniform density,3 cases of calcification,1 case of low density,1 case of slightly high density;19 cases of clear boundary,9 cases of unclear boundary;28 cases of lesions were only slightly enhanced;10 cases of intraluminal growth,11 cases of extraluminal growth,5 cases of internal and external bilateral growth,and 1 case of local thickening of the tube wall.Conclusion:(1)Endoscopic ultrasonography is superior to MSCT in the detection,diagnosis and origin of esophageal submucosal masses.(2)The detection rate of MSCT is affected by the maximum diameter of the lesion.When the maximum diameter of the lesion is larger than 13.9mm,the detection rate of MSCT and endoscopic ultrasonography is close.When the longest diameter of the lesion was less than 13.9mm,the tumor detection rate of MSCT was significantly lower than that of endoscopic ultrasonography.(3)MSCT can obtain three-dimensional diameter and volume of tumor,provide three-dimensional visualization image,and obtain comprehensive information of tumor and adjacent relationship,which is superior to esophageal ultrasound in providing only two-dimensional information.(4)MSCT and EUS combined examination is very necessary for the preoperative diagnosis and evaluation of SMTS,which can significantly improve the operation efficiency and reduce the complications of ESD and ster. |
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