术前64-SCTA探查血管受侵程度评价胰头恶性肿瘤可切除性的价值  

Preoperative evaluation of vascular involvement and general resectability of malignant pancreatic tumors by 64-slice spiral computed tomographical angiography

作　　者：张蕴[1] 范妤欣[1] 麻少辉[1] 荐志洁[1] 赵婷婷[1] 王林[2] 于良[2] 刘昌[2] 

机构地区：[1]西安交通大学医学院第一附属医院医学影像科,陕西西安710061 [2]西安交通大学医学院第一附属医院肝胆外科,陕西西安710061

出　　处：《胃肠病学和肝病学杂志》2013年第1期81-84,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨术前64层螺旋CT血管造影(64-SCTA)以血管受侵程度评价胰头恶性肿瘤可切除性的临床应用价值。方法3位医生回顾性分析33例胰头恶性肿瘤的术前64-SCTA资料,将胰头恶性肿瘤对邻近血管的侵犯程度分5级,分别对动脉、静脉的受侵程度与病变的可切除性进行评估,并与详细的手术记录进行了对照。结果 3位医生评价胰头恶性肿瘤对各血管受侵程度不完全相同,但依此评价经典切除术肿瘤可切除的总体结果基本一致,P>0.05。高年资医生评价经典切除术肿瘤可切除的敏感性为78.6%,特异性为94.7%,准确性为87.9%,阳性预测值为91.7%,阴性预测值为85.7%。Kappa=0.747(P<0.001);ROC曲线下面积为0.867(P<0.001)。低年资医生评价经典切除术肿瘤可切除的敏感性为50.0%,特异性为89.5%,准确性为72.7%,阳性预测值为77.8%,阴性预测值为70.8%。Kappa=0.414(P<0.05);ROC曲线下面积为0.697(P>0.05)。结论术前64-SCTA对胰头恶性肿瘤邻近血管是否受侵、受侵程度、病变经典切除术可切除性评价的临床应用价值较高。To investigate the preoperative evaluation of 64-slice spiral computed tomographical angiography（64-SCTA） to predict vascular involvement and general resectability of pancreatic head malignant tumors. Methods The material of 64-slice spiral computed tomographical angiography（64-SCTA） were retrospectively analyzed for pancreatic head malignant tumors in 33 cases by 3 doctors. Preoperative imaging findings were correlated with intraoperative and histopathologic results. Results Regarding respectability, the sensitivity, specificity, accuracy, positive predictive value（ PPV）, negative predictive value （NPV） of the experienced radiologist were 78.6% , 94.7% ,87.9% , 91.7% ,85.7% . Kappa value was 0. 747 （ P 〈 0. 001 ）. Receiver operator characteristic （ROC） analysis revealed an area under the curve （AUC） of 0. 867 （P 〈 0. 001 ）. Regarding respectability, these values of the primary radiologists were 50.0%, 89.5%, 72.7% 77.8%, 70.8%. Kappa value was0.414 （P〈0.001）. ROC analysis showed an AUC of 0. 697 （P 〉 0.05）. Conclusion 64-SCTA can provide reliable information for vascular involvement and general resectability of pancreatic malignant tumors. 64-SCTA has high value in clinical application.

关 键 词：胰腺肿瘤 恶性 体层摄影术 X线计算机 血管造影术 可切除性 预测 

分 类 号：R735.9[医药卫生—肿瘤]