双源CT检查对胰头癌淋巴结转移的诊断价值  

Diagnostic value of dual-source computed tomography for the lymphatic metastasis of the pancreatic headcancer

作　　者：蔡萍[1] 杜明珊[1] 李志超[1] 石彦姝[1] 杨景 王槐志 郭诗翔 王健[1] 

机构地区：[1]第三军医大学两南医院放射科,重庆400038 [2]病理科 [3]全军肝胆外科研究所

出　　处：《中华消化外科杂志》2013年第8期577-580,共4页Chinese Journal of Digestive Surgery

基　　金：重庆市自然科学基金计划项目（CSTC,2009BA5059）;重庆市高等教育教学改革研究项目（093099）

摘　　要：目的探讨舣源CT检查对胰头癌淋巴结转移的诊断价值。方法回顾性分析2007年12月至2009年12月第三车医大学西南医院收治的52例经病理检查结果证实的胰头癌患者的临床资料，所有患者行双源CT平扫和增强扫描，将CT图像上的淋巴结与病理标本比较，记录淋巴结的部位、数目，测量其短轴、长轴直径并计算各淋巴结的短长轴直径比，淋巴结的强化方式以及CT值的变化。分别以淋巴结短轴直径≥5、8、10mm作为淋巴结发生转移的诊断标准，统计各种不同标准的敏感度、特异度、阳性预测值、阴性预测值及准确度。汁量资料组问均数比较采用f检验，计数资料采用，检验。结果52例胰头癌患者淋巴结转移率为67．3％（35／52）。切除标本中共检出163枚淋巴结，病理检查诊断其中118枚发生转移。第13组与第17组、第12组、第14组、第16组淋巴结转移率分别为80．0％（28／35）、85．7％（30／35）、97．1％（34／35）、20．0％（7／35）。CT检查诊断环状强化的淋巴结转移率为100．0％（56／56），均匀强化的淋巴结转移率为71．0％（76／107），两者比较，差异有统计学意义（X^2=18．198，P〈0．05）。转移淋巴结CT值增加（25．0±3．3）HU，未转移淋巴结CT值增加（14．0±2．0）HU，两者比较，差异有统计学意义（t=22．732，P〈0．05）。转移淋巴结和未转移淋巴结的平均短轴直径、长轴直径、短长轴直径比分别比较，差异均有统计学意义（t=3．732，3．354，3．430，P〈0．05）。分别以淋巴结短轴直径≥5、8、10mm作为淋巴结发生转移的诊断标准，双源CT检查的敏感度分别为99．2％、43．2％和18．6％，特异度分别为22．2％、77．7％和88．9％，阳性预测值分别为77．0％、83．6％和81．5％，阴性预测值分别为10／11、34．3％和29．4％。结论双源CT检查能无创显示胰头癌淋巴结转移�Objective To investigate the diagnostic value of dual-source computed tomography （CT） for the lymphatic metastasis of the pancreatic head cancer. Methods The clinical data of 52 patients with pancreatic head cancer who were admitted to the Southwest Hospital from December 2007 to December 2009 were retrospec- tively analyzed. All patients received plain and enhanced scan by dual-source CT, and the distributions, number, short and long axis diameters and ratio of short- to long-axis diameter, enhancement modality and enhancement degree of lymph nodes were recorded by comparing the CT images and the pathological results. Different diagnostic thresholds including short-axis diameter greater than or equal to 5 mm, 8 mm or 10 mm were used as the criteria for judging lymph node metastasis. The sensitivities, speeifieities, positive- and negative-predictive values and the accuracies of the 3 criteria were calculated respectively. All data were analyzed using the t test or chi-square test. Results The positive rate of lymph node metastasis of the 52 patients was 67.3% （35/52）. Lymph node metastases were found in 118 out of 163 lymoh nodes. The metastatic rates of No. 13 and 17, 12, 14, 16 lymph nodes were 80.0% （28/35） , 85.7% （30/35） , 97.1% （34/35） , 20.0% （7/35） , respectively. The increased CT value of metastatic lymph nodes was （25.0±3.3 ） HU, which was significantly higher than （ 14.0±2.0） HU of patients with negative metastatic lymph nodes （t = 22. 732, P 〈 0.05 ）. The short- and long-axis diameters and the ratio ofshort- to long-axis diameter showed significant difference between metastatic and negative lymph nodes （ t = 3. 732, 3. 354, 3. 430, P 〈0.05）. The positive rate of lymphatic metastasis with rim-like enhancement was 100.0% （56/56）, which was significantly higher than 71.0% （76/107） of lymphatic metastasis with homogeneous enhancement （X^2= 18. 198, P 〈0.05）. Using the short axis diameters ≥5 mm, 8mm and 10 mm as the standards for diagnosing ly

关 键 词：胰腺肿瘤 淋巴结转移 体层摄影术 X线计算机 

分 类 号：R735[医药卫生—肿瘤] R730[医药卫生—临床医学]