MRCP诊断胆胰系疾病的价值评价及ROC分析  

Evaluated the value of diagnostic MRCP in patients with cholangiopancreatic disease by ROC

作　　者：吴梅[1] 郭启勇[1] 孙翀鹏[2] 马春梅[1] 陈胜利[3] 

机构地区：[1]中国医科大学附属第二医院放射科,辽宁沈阳110004 [2]广州医学院第一附属医院放射科,广东广州510120 [3]广州市第一人民医院放射科,广东广州510180

出　　处：《中国临床医学影像杂志》2006年第6期331-334,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:通过ROC分析,以及按病变部位、性质进行的亚组分析来评价US、CT和MRCP对胆胰系疾病的诊断价值,并简要介绍ROC的原理和应用。方法:收集疑胆胰系疾患接受MRCP检查患者105例,其中同时做US检查者65例。另有同期CT资料59例,其中同时做US检查者31例。每诊断一处病变计作一次诊断过程。病理检查、术中所见或临床、实验室检查结果作为诊断金标准。盲法与金标准对比,计算出各诊断方法的真阳性率和假阳性率,ROC分析其诊断效能。同时按病变部位、性质分别计算MRCP、US及CT的敏感度、特异度和似然比等指标,进行比较显著性检验统计。结果:ROC分析显示,MRCP的曲线最靠近左上角,US次之,CT在最下面,三者的曲线下面积(AZ)分别为0.985,0.981,0.901,均>0.9,MRCP与CT间离均差(Z)为0.75,双侧P>0.25。MRCP、US和CT诊断胆胰系恶性占位、结石的敏感度分别为100%、83%、82%;92%、71%、76%。经检验,MRCP与US和CT间有显著性差异,P<0.05。诊断胆总管结石3种方法差异较显著,敏感度分别为92%、39%、62%,经检验MRCP与US有显著性差别(χ2=17.412,P<0.001)。结论:ROC曲线分析是比较、评价2种或2种以上影像诊断方法效能差异性的客观标准。MRCP在诊断恶性胆道梗阻、胆道结石病变中较CT和US具有高的诊断效能。Objective： To evaluate the value of diagnostic ultrasound, CT and MRCP in patients with cholangiopancreatic disease by receiver operating characteristic curves（ROC）, and introduce the principle of ROC simply. Methods： One hundred and five patients suspected with cholangiopancreatic disease were collected. All patients were studied with MR. Of them, 65 patients underwent US examination. CT were performed in another 59 patients, of them, ultrasound was performed in 31 patients. Pathological results, operating findings or clinical and laboratorial examination results were the reference standard. Images were interpreted blindly to the reference standard. True positive rate and false positive rate were calculated respectively. We analysed the data with ROC. According to location and cause of the obstruction, sensitivity, specificity and likelihood ratio of MRCP, US and CT were calculated respectively. Chi-square test and Fisher test were used as statistical methods. Results： ROC curve showed MRCP curve lie in the top left corner. Area under the ROC curve（Az） of ultrasound, CT and MRCP were 0.981, 0.901 and 0.985 respectively. All Az value of them was higher than 0.9. But there was no significant difference between MRCP and CT（Z=0.75, P〉0.05）. According to location and cause of the obstruction, MRCP, US and CT had different diagnostic ability. ①The sensitivity of MRCP in distinguishing the various pancreato-biliary tumors was significantly higher than that of US and CT （P〈0.05）. ②The sensitivity of MRCP in diagnosing pancreato-biliary stones was significantly higher than that of US and CT（X^2=10.058 and 5.046, P〈0.05）. The sensitivity of MRCP, US and CT in diagnosing choledocholithiasis were 92%, 39% and 62% respectively. There was significant difference between MRCP and US（X^2=17.412, P〈0.001）. Conclusion： ROC analysis is an objective index for comparing and evaluating difference in efficiency of two or more imaging diagnostic methods. MRCP has better discriminatory power th

关 键 词：胆道疾病 胰腺炎 体层摄影术 X线计算机 胰胆管造影术 磁共振 

分 类 号：R575[医药卫生—消化系统] R576[医药卫生—内科学]