比较多层螺旋CT门静脉成像与内镜检查诊断肝硬化合并食管胃静脉曲张的优劣  

Comparison of multi-slice spiral CT portography and endoscopy in the diagnosis of esophageal and gastric varices in liver cirrhosis

作　　者：何欣[1,2] 黄仲奎[1] 龙莉玲[1] 韦启君[1] 蒋小红[1] 郭苹苹[1] 向超[1] 蓝江[1] 

机构地区：[1]广西医科大学第一附属医院放射科,南宁530023 [2]广西中医药大学第一附属医院放射科,南宁530023

出　　处：《中华放射学杂志》2012年第12期1092-1095,共4页Chinese Journal of Radiology

基　　金：国家自然科学基金资助项目（30760060）;广西自然科学基金资助项目（桂科自0728155）

摘　　要：目的探讨经多层螺旋CT门静脉成像（MSCTP）与消化内镜检查评估肝硬化并食管胃静脉曲张有无、分型、分级的一致性。方法前瞻性分析临床诊断为肝硬化的患者92例，4周内先后行消化道内镜及腹部MSCTP检查，观察食管、胃有无静脉曲张并进行分型、分级。以内镜结果作为金标准，对MSCTP与内镜判断食管胃静脉曲张的有无、分型、分级行Kappa一致性检验，并计算MSCTP诊断食管胃静脉曲张（EGV）的敏感度、特异度、一致率、Youden指数。结果内镜诊断食管胃静脉曲张阴性27例，阳性65例；食管胃静脉曲张分型：GOV1型45例、GOV2型19例、IGV1型1例。MSCTP诊断食管胃静脉曲张阴性25例，阳性67例；食管胃静脉曲张分型为：GOV1型46例、GOV2型18例、IGV1型3例。MSCTP发现内镜未诊断的2例IGV1型静脉曲张，其MSCTP表现为胃黏膜下孤立存在的胃静脉曲张。MSCTP与内镜EGV诊断结果一致性较高，Kappa=0．732，P〈0．01；MSCTP诊断EGV的敏感度93．8％，特异度77．8％，一致率89．1％，Youden指数71．6％。MSCTP与内镜EGV的分型及分级结果一致性均较高，Kappa值分别为0．743和0．763，P值均为〈0．01。结论MSCTP诊断肝硬化合并食管胃静脉曲张的有无、分型及分级，与消化内镜有较高的一致性。对于诊断胃静脉曲张，MSCTP优于内镜。Objective To study the correlation of multi-slice CT portography （MSCTP） and digestive endoscopy in the diagnosis and evaluation of esophageal and gastric varices （ EGV ） caused by cirrhosis. Methods A total of 92 patients with cirrhosis were enrolled in the prospective study. All the patients were examined by endoseopy and 64-slice spiral CT scan in 4 weeks. The types, grading of EGV were observed by endoscopy and MSCTP, and Kappa conformance test was applied with the endoscopic findings as gold standard. The sensitivity, specificity, consistency, and Youden index were evaluated for the diagnosis of sophageal and gastric varices by MSCTP. Results Sixty-five patients were diagnosed to have EGV by endoscopy and 27 were negative. The positive patients included 45 patients of GOV1, 19 of GOV2 and 1 patient of IGV1. MSCTP diagnosed 67 cases of EGV and 25 patients of negative results. The positive patients included 46 of GOV1, 18 of GOV2 and 3 of IGV1. Two patients of IGV1 varicose veins without positive findings on endoscopy were diagnosed by using MDCTP, which revealed isolated varicose veins under the gastric mucosa, There was high consistency between MSCTP and EGV in the diagnosis of EGV （Kappa =0. 732, P 〈 0. 01 ）. The sensitivity of MSCTP was 93.8% , specificity was 77.8%, consistency was 89. 1% , and Youden index 71.6%. There was high consistency between MSCTP and EGV in the classification of EGV （ Kappa values were 0. 743 and 0. 763, P 〈 0. 01 ）. Conclusions There is high consistency between MSCTP and digestive endoscopic in the diagnosis and classification of EGV in cirrhosis.MSCTP is superior to endoscopy in the detection of gastric varices.

关 键 词：肝硬化 食管和胃静脉曲张 体层摄影术 X线计算机 

分 类 号：R575.2[医药卫生—消化系统]