CT 强化值在表现不典型 T4a 期胃癌分期诊断中的应用价值  

CT enhancement value for staging untypical T4a gastric cancer

作　　者：左阳[1] 刘丽东[1] 苏丹柯[1] 金观桥[1] 朱旭娜[1] 赵欣[1] 刘宇[1] 刘思远[1] 

机构地区：[1]广西医科大学附属肿瘤医院影像中心,广西南宁530021

出　　处：《实用放射学杂志》2015年第8期1283-1286,共4页Journal of Practical Radiology

摘　　要：目的：探讨 CT 强化值及形态学表现在不典型 T4a 期胃癌分期诊断中的参考价值。方法回顾性分析 CT 表现为浆膜面光滑的胃癌 T3、T4a 期术后病例共51例。采用盲法在胃壁浆膜下紧临浆膜处病灶区选取感兴趣区并测量平扫、动脉期、静脉期的 CT 值，使用 SPSS22.0计算各期 CT 值及动、静脉期强化值的均数，使用 Medcalc12.7绘制受试者工作特征曲线（ROC）并采用 Z检验分析各期 CT 值及动、静脉期 CT 强化值对胃癌 T4a 期分期诊断效能间的差异性（P 〈0.05）；使用 Medcalc12.7采用 Z 检验法分析前述 CT 值法诊断效能最佳者与常规 CT 形态学诊断标准（即病灶浆膜面有无结节状突起等）及二者相结合法诊断胃癌 T4a 期诊断效能间的差异性（P〈0.05），并计算3种方法诊断敏感度及特异度。结果 CT静脉期-平扫强化值诊断效能最佳，以 CT 强化值43.6 HU 为胃癌 T4a 期诊断阈值时，敏感度为74.07%，特异度为70.83%，曲线下面积（AUC）0.82；常规 CT 形态学诊断标准的敏感度为66.67%，特异度为33.33%；将常规 CT 形态学诊断标准与 CT静脉期-平扫强化值并联结合后诊断敏感度为100.00%，特异度为26.31%。结论CT静脉期-平扫强化值对胃癌 T4a 期的诊断效能高于常规 CT 形态学诊断标准。Objective To evaluate the diagnostic performance of enhancement value and morphological features by using mul-tiphasic MDCT on differentiating untypical T4a from T3 gastric cancer.Methods Fifty-one histopathologically proven T3 and T4a gastric cancer patients with smooth serosa were collected retrospectively.Three radiologists read all images regarding morphological features,while the CT value and enhancement value of regions of interest （ROIs）located in the outer of lesion were calculated.Cut-off analysis was performed to determine optimal threshold levels of enhancement value to discriminate T4a and T3 gastric cancer.Di-agnostic performance of enhancement value and combination of enhancement value and morphologic assessment were compared with morphologic assessment by means of receiver operating characteristic （ROC）curve analysis.Results The sensitivity and specificity of morphological features was 66.67% and 33.33% respectively;the area under the ROC of enhancement value （between venous phase and plain scan）for differentiating T4a from T3 gastric cancer was 0.82,with a cut-off at 43.6 HU,sensitivity of 74.07% and specificity of 70.83%.Combined conventional standard and enhancement value,sensitivity of 100.00% and specificity 26.31%. Conclusion For differentiation of T4a and T3 gastric cancer by means of MDCT,enhancement value is found to be superior to con-ventional standard.

关 键 词：胃癌 计算机体层成像 T分期 

分 类 号：R735.2[医药卫生—肿瘤]