胸腺上皮肿瘤术前CT影像分期诊断可重复性的临床研究  

CT imaging features of thymic epithelial tumors and reproducibility of preoperative staging diagnosis

作　　者：谷志涛[1] 沈艳[2] 茅腾[1] 陈文虎[1] 方文涛[1] 

机构地区：[1]上海交通大学附属胸科医院胸外科,200030 [2]上海交通大学附属胸科医院放射科,200030

出　　处：《中华胸部外科电子杂志》2015年第1期8-12,共5页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的分析胸腺上皮肿瘤的CT影像特点，探讨其用于术前分期诊断的可重复性。方法嘲顾性收集2010年4至7月上海交通大学附属胸科医院手术和病理确诊的30例胸腺上皮肿瘤患者的临床资料，参照国际胸腺肿瘤协作组织提议并倡导的胸腺肿瘤CT影像诊断标准分析，分析3位观察者之间CT影像用于描述肿瘤特征、评估术前肿瘤外侵范围的可重复性及与术后病理诊断的一致性。3位观察者中以职称为主任医师的主刀医师作为主要观察者，1名胸外科5年工作经历的主治医师及1名放射科10年工作经历的主治医师作为对照观察者。Kappa值为0～0．40时，提示诊断的一致性不好；0．41～0.75时，提示诊断的一致性较好；0．76～1．00时，提示诊断的一致性好。结果对于胸腺上皮肿瘤的基本影像特点，如肿瘤位置、轮廓、密度的判断，3位观察者的一致性较好（Kappa值为0．634～0．821）；对肿瘤外形、强化形式、钙化的判断，主要观察者与另外两位观察者之间的一致性较好（Kappa值为0．4～0.626），而胸外科医师与放射科医师之间的诊断一致性较差（Kappa值为0．216～0．313）；对于肿瘤侵犯纵隔脂肪和肺的判断，3位观察者诊断的一致性较差（Kappa值为0．104～0.585）；对于肿瘤侵犯纵隔胸膜、心包、纵隔大血管以及膈神经的判断，3位观察者诊断的一致性较好（Kappa值为0．38～0．839）。3位观察者对肿瘤侵犯纵隔脂肪、胸膜的诊断与术后病理结果相比，一致性较差（Kappa值为0．203～0．493）；主要观察者对肿瘤侵犯肺的诊断与术后病理结果相比，一致性较差（Kappa值为0．135），其余2位观察者的诊断结果一致性较好（Kappa值为0．366～0．712）；3位观察者对肿瘤侵犯心包、纵隔大血管以及膈神经的诊断与术后病理结果相比，一致性较好（Kappa值为0．366～0．87）。结论CT可用�Objective To explore the CT imaging features of thymic epithelial tumors, and evaluate the reproducibility of preoperative staging diagnosis. Methods The clinical data of 30 patients with thymic epithelial tumors confirmed by surgery and pathology in Shanghai Chest Hospital affiliated to Shanghai Jiao Tong University between April 2010 and July 2010 were retrospectively collected. Based on the CT imaging diagnosis criteria proposed by International Thymic Malignancy Interest Group, the comparative analysis of description of tumor characteristics by three observers with CT was done, and the reproducibility of assessment of extent of tumor invasion before operation and consistency with postoperative pathological diagnosis were evaluated. The senior surgeon was served as primary observer, and one thoracic surgeon with 5 years working experience and one radiologist with 10 years working experience were served as control observers. Kappa value of 0 to 0. 40 indicated a poor diagnosis consistency, Kappa value of 0.41 to 0.75 a fair diagnosis consistency, and Kappa value of 0.76 to 1.00 a good diagnosis consistency. Results For imaging features of thymic epithelial tumors, such as the diagnosis of tumor location, density and contour, three observers agreed well（Kappa value, 0. 634- 0. 821）. For judgment of tumor contour, heterogeneous attenuation and calcification, the primary observer mostly consisted with the other two observers（Kappa value, 0.4-0. 626）, while the diagnosis of the other thoracic surgeon and radiologist showed poor consistency（Kappa value, 0. 216-0. 313）. For judgment of tumor invasion to mediastinal fat or lung, the diagnosis consistency of three observers was poor（Kappa value, 0. 104-0. 585）, while the diagnosis consisteney for judgment of tumor invasion to mediastinal pleural, pericardial or mediastinal great vessels and phrenic nerve was fair（Kappa value, 0.38-0. 839）. The diagnosis of invasion to mediastinal fat and pleura by three observers was poorly consistent with postopera

关 键 词：胸腺瘤 诊断显像 肿瘤分期 

分 类 号：R736.3[医药卫生—肿瘤] R730.44[医药卫生—临床医学]