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1、胃十二指肠Stomach Stomach DuodenalDuodenal气钡双重造影是最常用和重要的方法。注意点：透视与照片结合形态与功能并重充盈下适当加压辅助药物的合理使用多相影像的分析： 充盈相；加压相； 粘膜相；双重相。胃底胃底胃大弯胃大弯贲门贲门胃小弯幽门幽门幽门幽门影像解剖影像解剖十二指十二指十二指十二指肠球部肠球部肠球部肠球部十二指十二指十二指十二指肠降部肠降部肠降部肠降部胃体胃体胃体胃体胃窦胃窦胃窦胃窦溃疡病 胃胃 溃溃 疡疡 好发于2050岁。十二指肠溃疡发病率是胃溃疡的 5倍。反复、周期性、节律性上腹部疼痛。不良的饮食嗜好有损胃粘膜的药物紧张、过度刺激诱发诱发胃酸水平紊乱胃
2、溃疡1cm1cm大小大小 急性溃疡急性溃疡多发急性溃疡多发急性溃疡发病机制病理改变病理改变浅表溃疡溃疡穿透性溃疡1cm穿孔性溃疡溃疡从粘膜开始，侵犯粘膜下层，常达肌层。直径多为520mm，深510 mm。溃疡口部周围呈炎症水肿。病理改变病理改变浅表溃疡溃疡穿透性溃疡1cm穿孔性溃疡穿透性溃疡慢性溃疡深达浆膜层。胼胝性溃疡溃疡周围有坚实的纤维组织增生。病理改变病理改变浅表溃疡溃疡穿透性溃疡1cm穿孔性溃疡溃疡疤痕变形和狭窄复合性溃疡胃和十二指肠同时溃疡。溃疡恶性变见于胃溃疡。病理改变病理改变溃疡的形态圆形、线性胃溃疡影像表现胃溃疡影像表现（1）龛 影1、圆形溃疡、圆形溃疡龛影口部由于水肿向溃疡腔
3、内翻卷的粘膜龛影口部由于水肿向溃疡腔内翻卷的粘膜(1)龛 影特殊类型的溃疡穿透性溃疡，穿孔性溃疡，胼胝性溃疡(1)龛 影穿透性溃疡气体液体钡剂溃疡底光滑整齐(2)溃疡底部龛影口部的水肿带是良性龛影的特征，常见表现如下：（1）粘膜线（2）项圈征（3）狭颈征粘膜皱襞均匀性向龛影口部纠集是良性龛影的另一个特征（3）溃疡口口部粘膜线口部粘膜线溃疡堤溃疡堤粘膜线粘膜线项圈征项圈征（3）溃疡口龛影口部的粘膜线溃疡堤溃疡堤粘膜线粘膜线项圈征项圈征（3）溃疡口口部的粘膜线溃疡堤溃疡堤粘膜线粘膜线项圈征项圈征（3）溃疡口项圈征溃疡堤溃疡堤粘膜线粘膜线项圈征项圈征（3）溃疡口溃疡堤溃疡堤粘膜线粘膜线项圈征项圈征狭
4、颈征口部明显狭小口部明显狭小（3）溃疡口胃角小溃疡，周围粘膜向口部集中（4）粘膜纠集胃体小弯侧溃疡，周围粘膜向口部集中溃疡底部溃疡底部充盈缺损充盈缺损（4）粘膜纠集粘膜皱襞纠集（4）粘膜纠集粘膜皱襞纠集（4）粘膜纠集（4）粘膜纠集良性溃疡良性溃疡（4）粘膜纠集龛影切迹胃小弯缩短（5）胃变形（5）胃变形小弯溃疡，小弯缩短，蜗牛胃（5）胃变形幽门溃疡，幽门变形狭窄（6）幽门梗阻幽门梗阻造成胃扩张（6）幽门梗阻2、线性溃疡（线性疤痕）（线性疤痕）小弯溃疡小弯溃疡纤维增生纤维增生小弯缩短小弯缩短呈蜗牛胃呈蜗牛胃2、线性溃疡3 3、多发溃疡、多发溃疡4、特殊部位溃疡胃远处溃疡胃近端溃疡胃近端溃疡4、特殊
5、部位溃疡十二指肠溃疡十二指肠溃疡十 二 指 肠 溃 疡 好发于2050岁。十二指肠溃疡发病率是胃溃疡的 5倍。反复、周期性、节律性上腹部疼痛。影像解剖影像解剖十二指肠球部降段水平段幽门管十十 二二 指指 肠肠 溃溃 疡疡 影影 像像 表表 现现正常十二指肠球部正常十二指肠球部十十十十 二二二二 指指指指 肠肠肠肠 溃溃溃溃 疡疡疡疡90%发生在球部，多在后壁球部溃疡球部溃疡（壶腹部溃疡）（壶腹部溃疡）圆形溃疡伴一侧变形圆形溃疡伴一侧变形球部溃疡球部溃疡球部变形球部变形Contrast-enhanced axial CT scan through the liver shows a collec
6、tion of air anterior to the liver, as depicted in the diagram in Image 15. Also note the air surrounding the gallbladder and the leakage of water-soluble contrast material from a perforated duodenal ulcer.Nonenhanced axial CT through the tip of the liver in the same patient as in Images 18 and 19 sh
7、ow leakage of oral contrast material (arrows) from a perforated gastric ulcer.(Left) Upper GI barium series in a patient who presented with acute abdominal pain. Note the duodenal ulcer crater and air within the ligamentum teres (arrow). (Right) Follow-up barium study shows that the barium leak and
8、air within the ligamentum teres (arrow) persists.胃癌一、早期胃癌隆起型隆起型凹陷型凹陷型浅表平坦型浅表平坦型Japanese classification of early gastric cancer 早 期 胃 癌浅表平坦型Early gastric cancer. A type IIc lesion is manifested by shallow, irregular areas of ulceration and nodularity (arrows) in the gastric antrum. Early gastric canc
9、er (type III) in 66-year-old woman. AC, Transverse dynamic contrast-enhanced CT images show enhancing tumor from arterial phase to delayed phase. There is a low-attenuation strip (arrow) representing the submucosal layer in outer tumor border; this finding suggests pathologic stage T1. Also shown is
10、 a well-enhanced lymph node (arrowhead) in infrapyloric region. D, Coronal MPR shows well-enhanced mucosal tumor (arrow) with visible outer submucosal layer and clear fat plane around gastric wall. E, Photomicrograph shows submucosal invasion of early gastric cancer (pT1). (Hematoxylin-eosin stain;
11、original magnification, 10.) F, Virtual gastroscopy image shows excavated lesion (arrow) at gastric antrum. G, Conventional gastroscopy revealed a similar excavated ulcerated lesion (arrow). 隆起型隆起型Abdominal CT revealed a submucosal lesion in the gastric wall.A.CTVE示胃体上部表浅隆起型病变；示胃体上部表浅隆起型病变；B.胃镜示胃体上部
12、局部浅表性隆起性病变，与胃镜示胃体上部局部浅表性隆起性病变，与CTVE的表现类似的表现类似AB粘膜破坏粘膜破坏粘膜破坏粘膜破坏凹陷型早 期 胃 癌早 期 胃 癌胃溃疡恶变粘膜杵状增粗中断正常胃粘膜凹陷型凹陷型早 期 胃 癌粘膜皱襞平坦浅表平坦型早 期 胃 癌肿瘤胃微皱襞改变：胃小沟破坏、消失，呈不规则条纹浅表平坦型浅表平坦型二、进展期胃癌Borrmann classification of advanced gastric cancer.粘膜破坏，龛影口部隆起成环堤进展期胃癌病理分型蕈伞型（息肉型、肿块型、增生型）浸润型溃疡型临床表现上腹痛，吐咖啡色血或柏油样便，上腹部肿块。1、各类型胃癌影像
13、表现Borr I Borr I 型型 巨块型，蕈伞型巨块型，蕈伞型Borr II Borr II 型型 局限溃疡型局限溃疡型Borr IIIBorr III型型 浸润溃疡型浸润溃疡型Borr IV Borr IV 型型 弥漫浸润型弥漫浸润型 进 展 期 胃 癌胃角肿块阴影，双重造影勾画胃角肿块阴影，双重造影勾画出肿瘤的轮廓出肿瘤的轮廓Borr I 型型 巨块型，蕈伞型巨块型，蕈伞型进 展 期 胃 癌Borr I 型型 巨块型，蕈伞型巨块型，蕈伞型充盈缺损充盈缺损Borr I 型型 巨块型，蕈伞型巨块型，蕈伞型进 展 期 胃 癌Borr I 型型 巨块型，蕈伞型巨块型，蕈伞型进 展 期 胃 癌进
14、 展 期 胃 癌Borr I 型型 巨块型，蕈伞型巨块型，蕈伞型Gastric gastrointestinal stromal tumor (GIST). In 63-year-old woman with gastric GIST, axial contrast-enhanced CT scan of upper abdomen shows large heterogeneously enhancing tumor in stomach and ulcer filled with oral contrast agent (arrow).Polypoid gastric carcinoma.
15、 A polypoid mass (arrow) is seen on the greater curvature of the stomach. Advanced T3 gastric cancer (Borrmann type I + II) in 65-year-old man. A, Coronal oblique arterial phase MPR shows well-enhanced hyperintense mucosal tumor with a nodular outer border of the stomach and reticular strands (arrow
16、) in the fat plane contiguous with the outer border of the tumor; these findings suggest pathologic stage T3. B, Coronal oblique delayed phase MPR image shows transmural hyperintense tumor with irregular outer border of the stomach and reticular strands (arrow) in the fat plane contiguous with the o
17、uter border of the tumor in antrum of stomach; these findings suggest pathologic stage T3. C, Gross and, D, histologic specimen show extraserosal invasion of gastric cancer (pT3). (Hematoxylin-eosin stain; original magnification, 5.) E, Virtual gastroscopy image shows protruding mass (arrow) with ul
18、cerated tumor. F, Conventional gastroscopy showed a similar finding (arrow). Secondary achalasia（失弛缓）（失弛缓） caused by gastric carcinoma. View of stomach from the same examination (Fig. 1) reveals a diffusely infiltrating carcinoma of gastric body and fundus that has invaded the distal esophagus. Plai
19、n abdominal radiographic findings of gastric carcinoma. Close-up view from an abdominal radiograph shows a soft tissue mass (arrows) indenting the lesser curvature of the gas-filled stomach. This was a polypoid gastric carcinoma. Synchronous gastric carcinomas. Two discrete polypoid masses (arrows)
20、are seen in the stomach due to separate primary gastric carcinomas. Menetriers disease. In this patient, masslike protrusions of the folds are seen on the greater curvature of the gastric body on a barium study. This appearance could be mistaken for a polypoid gastric carcinoma. The distal antrum is
21、 relatively spared. Mntrier disease causes the ridges along the inside of the stomach wallcalled rugaeto enlarge, forming giant folds in the lining of the stomach. The rugae enlarge because of an overgrowth of surface mucous cells of the stomach. H. pylori causing localized polypoid gastritis. Focal
22、ly thickened, lobulated folds are seen in the gastric body (arrows). These findings are worrisome for a localized lymphoma or submucosally infiltrating carcinoma. In this patient, however, endoscopic biopsy specimens revealed H. pylori gastritis without evidence of tumor. Borr II Borr II 型型 局限溃疡型局限溃
23、疡型Spot radiograph of the vertically oriented gastric antrum from a double-contrast upper GI series. The normal areae gastricae pattern of the stomach is replaced by a 4 cm area of coarsely lobulated mucosal nodules (long arrows). Centrally, a flat depression is coated, but not filled, with barium (s
24、hort arrow). Large, round and polygonal nodules of varying size (2-5 mm) surround the flat depression. Ulcerated gastric carcinoma. Double-contrast view of the stomach shows a relatively large mass that is etched in white (large arrows) near the lesser curvature of the gastric body. Also note a seco
25、nd curvilinear density (small arrows) due to barium coating the rim of an unfilled central ulcer. (From Laufer I, Levine MS eds: Double Contrast Gastrointestinal Radiology, 2nd ed. Philadelphia, WB Saunders, 1992.) Advanced T2 gastric cancer in 56-year-old man. A, Transverse CT image shows focal wel
26、l-enhanced hyperintense mucosal tumor (arrow) with visible outer low-attenuation strip and a clear fat plane around the tumor; these findings suggest pathologic stage T1. B, Coronal oblique MPR shows focal transmural involvement of the hyperintense mucosal tumor (arrow) in the superior aspect of the
27、 gastric antrum; this finding suggests pathologic stage T2. This lesion proved to be a subserosal invasion of gastric cancer (pT2). A 轴位轴位CT增强胃窦部大弯侧胃壁局限增厚强化，中心可见溃疡形成；图增强胃窦部大弯侧胃壁局限增厚强化，中心可见溃疡形成；图 B MPR示胃窦部大弯侧胃壁局限增厚强化，示胃窦部大弯侧胃壁局限增厚强化，中心可见表浅溃疡形成，增厚胃壁外缘光整；图中心可见表浅溃疡形成，增厚胃壁外缘光整；图 C CTVE 示胃窦部凹凸不平，周围可见小结节状隆
28、起；图示胃窦部凹凸不平，周围可见小结节状隆起；图 D SSD示示胃窦部大弯侧胃壁局限性凹陷；图胃窦部大弯侧胃壁局限性凹陷；图 E 胃镜示胃窦部局限性溃疡性病变，溃疡中心可见少量白苔附着；图胃镜示胃窦部局限性溃疡性病变，溃疡中心可见少量白苔附着；图 F 手术标本手术标本所见与所见与CTVE类似类似ABCDECBorr III型型 浸润溃疡型浸润溃疡型肿肿瘤瘤周周围围粘粘膜膜受受侵侵犯犯而而变变平平僵僵硬硬Borr III型型 浸润溃疡型浸润溃疡型(A) Abdominal computed tomography (CT) revealed enhanced thickness of the ga
29、stric wall and multiple liver metastases. (B) Gastroscopy revealed a Borrmann type III tumor on the lesser curvature in the midportion of the stomach.Borr III型型 浸润溃疡型浸润溃疡型Advanced gastric cancer (Borrmann type III) in 50-year-old woman. A, Virtual gastroscopy image shows typical ulcerated carcinoma
30、in stomach body. B, Surgical specimen shows a similar lesion. CE, Transverse dynamic contrast-enhanced CT images obtained in, C, arterial phase, D, portal venous phase, and, E, delayed phase show transmural, gradually enhancing tumor (arrow) with smooth outer border of gastric wall; these findings s
31、uggest pathologic stage T2. F, Photomicrograph shows subserosal invasion of gastric cancer (pT2). (Hematoxylin-eosin stain; original magnification, 5.) Borr III型型 浸润溃疡型浸润溃疡型Advanced T4 gastric cancer in 59-year-old woman. A, Transverse CT image shows well-enhanced tumor with adjacent fat plane infil
32、tration (arrow) adjacent to transverse colon with normal morphology; these findings suggest pathologic stage T3. B, Coronal oblique MPR shows obliteration of fat planes (arrow) between cancer and transverse colon and direct tumor invasion of the superior margin of transverse colon; these findings su
33、ggest pathologic stage T4. C, D, Gross specimens show direct colonic invasion (arrow) of gastric cancer (pT4). Borr III型型 浸润溃疡型浸润溃疡型Ulcerated gastric carcinoma. (See Fig. 11) Prone compression view shows the mass as a radiolucent filling defect (black arrows) on the anterior wall of the stomach. Not
34、e how the central ulcer (white arrows) fills with barium when the patient is in the prone position. The ulcer has a convex inner border and an intraluminal location, demonstrating the features of a Carman-Kirkland meniscus complex. (From Laufer I, Levine MS eds: Double Contrast Gastrointestinal Radi
35、ology, 2nd ed. Philadelphia, WB Saunders, 1992.) 胃腔狭窄僵硬Borr IV Borr IV 型型 弥漫浸润型弥漫浸润型进 展 期 胃 癌Plain abdominal radiographic findings of gastric carcinoma. In this patient, the gas-filled stomach has a narrowed, tubular appearance (arrow) due to a scirrhous carcinoma (linitis plastica). Borr IV Borr IV
36、 型型 弥漫浸润型弥漫浸润型Borr IV Borr IV 型型 弥漫浸润型弥漫浸润型Figure 1: Contrast enhanced CT of the abdomen showing pathologic thickening of gastric wall (a), multiple enlarged lymphnodes (b), ascites and an enhancing solid mass in the left ovary (c). 淋淋巴巴结结转转移移Advanced gastric cancer in 63-year-old woman. Coronal obl
37、ique MPR shows cluster of enhancing small nodes (arrows) around infrapyloric region. Histopathologic examination revealed metastatic nodes. One enlarged solitary node with poorly enhancing ovoid shape (arrowhead) is seen along greater curvature. However, pathologic examination showed a reactive patt
38、ern. 56-year-old man with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. CT scan shows circular growth of MALT lymphoma (arrow) at gastric angle mimicking carcinoma. As with most gastrointestinal lymphomas, there is no luminal stenosis.2、特殊部位的胃癌贲门癌贲门癌胃窦癌胃窦癌胃底肿块阴影贲门癌贲门癌Secondary achalasia
39、 or pseudoachalasia. Fluoroscopy in this patient revealed esophageal dilatation and aperistalsis. However, there is irregular tapering of the esophagogastric region due to gastric carcinoma. Spot radiograph from double-contrast upper GI series with patient in right lateral, but erect position obtain
40、ed while the barium bolus is passing through the distal esophagus. The normal, thin radiating folds of the gastric cardia have been replaced by large, nodular folds (large arrows). Nodular mucosa is seen in the distalmost 1 cm of esophagus (small arrow). Spot radiograph obtained during double-contra
41、st upper GI series with patient in right side down position (right lateral). The folds of the gastric cardia are mildly thickened and slightly nodular (arrows). Esophageal involvement by gastric lymphoma. Irregular narrowing (arrows) of distal esophagus due to contiguous spread of lymphoma from gast
42、ric fundus. Carcinoma of gastric cardia invading the distal esophagus could produce identical findings. (From Levine MS: Radiology of the Esophagus. Philadelphia, WBSaunders, 1989.) Direct esophageal invasion by carcinoma of the gastric cardia. Double contrast view of the fundus shows obliteration o
43、f the normal anatomic landmarks at the cardia with a centrally ulcerated polypoid lesion (straight arrows) extending into the distal esophagus (curved arrow). (From Levine MS, Laufer I, Thompson JJ: Carcinoma of the gastric cardia in young people. AJR 140:69-72, 1983, by American Roentgen Ray Societ
44、y.) Direct esophageal invasion by gastric carcinoma. Lateral view of the gastric fundus shows a large fundal mass (black arrows) containing an eccentric area of ulceration (white arrow). This patient had a primary gastric carcinoma invading the distal esophagus. (From Levine MS: Radiology of the Eso
45、phagus. Philadelphia, WB Saunders, 1989.) 溃溃疡疡Advanced esophageal carcinoma with a squamous cell metastasis to the stomach. There is a giant submucosal mass (black arrows) in the gastric fundus, containing a triangular area of central ulceration (white arrows). A malignant gastrointestinal stromal t
46、umor could produce similar findings. (From Levine MS: Radiology of the Esophagus. Philadelphia, WB Saunders, 1989.) Figure 2 : Conglomerate mass of gastric varices (also known as tumorous varices). Barium study shows a large, lobulated submucosal mass (arrows) on the medial aspect of the gastric fun
47、dus. Although this lesion could be mistaken for a malignant gastrointestinal stromal tumor or even a polypoid carcinoma, note its smooth, undulating contour.这是贲门癌吗？胃窦癌胃良性溃疡与恶性溃疡鉴别观察要点龛影的形状龛影的位置龛影口部和周围粘膜情况附近胃壁1.龛影周围出现小结节状充盈缺损，如指压迹；2.周围粘膜皱襞杵状增粗和中断；3.龛影周围不规则或边缘出现尖角征；4.治疗过程龛影增大。胃溃疡恶变指压征胃溃疡恶变龛影口部出现指压征，粘膜
48、不规则增粗中断胃溃疡恶变胃良性溃疡？恶性溃疡？Spot radiograph of the upper gastric body from a double-contrast upper GI series. There is a shallow, barium etched crater (C). Small, 2-3 mm, round and polygonal radiolucent nodules line the surface of the ulcer. Nodular folds (arrows) radiate toward the ulcer forming a nodul
49、ar collar of tissue around the edge of the crater. The tumor is about 4 cm in greatest surface dimension, but remains relatively flat.Spot radiograph from double-contrast upper GI series. There is a 1.5 cm area containing five polygonal, flat nodular elevations 25 mm in greatest dimension (arrowhead
50、s). Barium fills the spaces between nodules. At least five folds radiate to this region. The folds have clubbed, lobulated heads (arrows). 胃窦癌与胃窦炎的X线鉴别诊断观察要点粘膜皱襞轮廓胃壁柔软度蠕动病变与正常分界有否肿块 胃窦良恶性狭窄的鉴别Figure 3 : Gastric outlet obstruction caused by an annular carcinoma of the antrum. There is irregular narro
51、wing of the distal antrum (arrow) with proximal dilatation of the stomach. (From Eisenberg RL: Gastrointestinal Radiology: A Pattern Approach, 3rd ed. Philadelphia, JB Lippincott, 1996.)H. pylori causing localized polypoid gastritis. Focally thickened, lobulated folds are seen in the gastric antrum.
52、 These findings are worrisome for a localized lymphoma or submucosally infiltrating carcinoma. In this patient, however, endoscopic biopsy specimens revealed H. pylori gastritis without evidence of tumor. 胃肉瘤Sarcoma of the stomach（Gastrointestinal Stromal Tumors GIST ）淋巴瘤特点病灶明显，临床情况却不差病变虽然广泛，但胃蠕动与收缩
53、存在胃粘膜广泛增粗，形态固定胃内多发或广泛肿块伴溃疡其他部位淋巴瘤表现平滑肌肉瘤特点分型：胃内；胃外；混合型（哑铃）临床：无特异性影像：光滑或分叶的充盈缺损+溃疡Gastrointestinal stromal tumor (GIST). Image obtained 1 year later in the same patient .The mass has increased in size. A GIST was found at surgery.Gastric gastrointestinal stromal tumor in a 49-year-old woman. The mass
54、 was found incidentally during an upper GI workup for peptic disease. The smooth appearance suggests a submucosal process. Gastrointestinal stromal tumor (GIST). CT scan obtained in the same patient shows the same GIST. It appears as an intramural mass with both exophytic and endophytic components.G
55、astrointestinal stromal tumor with central bulls eye appearance, which is compatible with contrast material collection in an ulceration.Gastric gastrointestinal stromal tumor (GIST) en face. Upper GI image obtained during the single contrast enhancement portion shows an incidentally found mass. The
56、smooth borders suggest a submucosal process. At surgery, a GIST was found. Gastric gastrointestinal stromal tumor with huge exophytic component, which has become ulcerated. Barium collects in the exophytic ulcer crater (arrows).Gastrointestinal stromal tumor (GIST). CT scan obtained in the patient i
57、n Image 12 demonstrates the GIST with large exophytic（外生性）（外生性） ulceration (arrows).Malignant gastrointestinal stromal tumor on CT. A large, heterogeneous exogastric mass (asterisk) is seen arising from the posterior wall of the stomach. An ulcer crater (arrow) on the posterior wall of the stomach i
58、dentifies the gastric wall as the origin of this mass. The heterogeneous enhancement and large size of the lesion strongly correlate with malignant histology. Malignant gastrointestinal stromal tumor on CT. In this patient, a heterogeneous exogastric mass is seen insinuating between the stomach and
59、pancreas. massstomachMalignant gastrointestinal stromal tumor on CT. In this patient, a gas- and fluid-filled mass projects posteriorly from the stomach. Although uncommon, this degree of necrosis can occur with malignant GISTs. Exogastric malignant gastrointestinal stromal tumor. CT scan reveals a
60、giant heterogeneous mass with multiple low-density areas due to necrosis of tumor. This heterogeneous appearance is characteristic of malignant GISTs on CT. (Courtesy of Hans Herlinger, MD, Philadelphia, PA.) Malignant gastrointestinal stromal tumor with necrosis on CT. Non-contrast-enhanced CT scan
61、 shows a water-attenuation mass arising from the anterolateral wall of the stomach. Malignant gastrointestinal stromal tumor on CT. Off-axis coronal volume-rendered MDCT image shows a large mass arising from the lesser curvature of the stomach. The wall of the lesion (arrowheads) is irregularly thic
62、kened. Exogastric malignant gastrointestinal stromal tumor with calcification. A giant exogastric mass causes displacement and compression (arrows) of the lesser curvature of the stomach. Mottled areas of calcification are seen in the tumor. Malignant gastrointestinal stromal tumor. A large, lobulat
63、ed submucosal mass is seen in the gastric fundus. Malignant gastrointestinal stromal tumor of the duodenum. Barium study shows a large intramural mass (arrows) on the lateral border of the descending duodenum. Malignant gastrointestinal stromal tumor with cavitation. A giant mass is present in the s
64、tomach. Barium is trapped within irregular cavities in the mass. (A courtesy of Hans Herlinger, MD, Philadelphia, PA.) Malignant gastrointestinal stromal tumor with cavitation. A cavitated lesion is manifested by a giant extraluminal collection of barium (arrows). Exogastric malignant gastrointestin
65、al stromal tumor. Lateral radiograph of the stomach shows a giant exogastric mass compressing the posterior wall of the gastric fundus (small arrows). A central dimple or spicule (large arrow) is seen at the site of attachment of the mass. This finding should suggest the possibility of an exogastric
66、 GIST. (Courtesy of Hans Herlinger, MD, Philadelphia, PA.) Malignant gastrointestinal stromal tumor with necrosis. FDG PET image shows increased activity (arrowheads) in the periphery of the mass. Viable tissue is typically located in the periphery of malignant GISTs that are highly necrotic. 良性间叶肿瘤
67、观察胃壁的厚度（正常5mm）；可显示胃壁肿瘤，腹腔淋巴结，转移等，明确分期。胃平滑肌肉瘤，肝广泛转移Metastatic breast cancer involving the stomach with a linitis plastica appearance. There is only mild loss of distensibility of the gastric antrum and body, but the mucosa has a nodular, irregular appearance because of infiltration by metastatic tumor. (From Levine MS, Kong V, Rubesin SE, et al: Scirrhous carcinoma of the stomach: Radiologic and endoscopic diagnosis. Radiology 175:151-154, 1990.) 胃息肉 Hyperplastic Polyps 下课啦下课啦
