食管癌转移淋巴结多层螺旋CT诊断标准探讨  

The criteria for preoperative diagnosis of metastatic lymph nodes by multi-slice spiral CT in esophageal cancer

作　　者：刘剑芳[1] 邵华飞[1] 屈东[1] 刘戬[1] 姚丽波[1] 王铸[1] 

机构地区：[1]中国医学科学院肿瘤医院影像诊断科,北京100021

出　　处：《癌症进展》2016年第1期56-58,共3页Oncology Progress

基　　金：国家自然科学基金(61372192)

摘　　要：目的通过多层螺旋CT薄层多平面重建图像所见与病理结果对照,探讨转移淋巴结的诊断标准。方法以病理诊断为金标准,回顾性分析208例胸段食管癌患者淋巴结的术前多层螺旋CT多平面重建图像,测量淋巴结的长径、短径,计算出直径比(短径/长径,将淋巴结直径比≥0.7视为圆形淋巴结),同时观察淋巴结有无环形强化、成簇分布、边缘模糊等影像学特征,分析比较各项指标的诊断价值。结果以短径≥1.0 cm作为转移淋巴结的诊断标准,敏感度为23.6%,特异度为98.6%,约登指数为0.22。以短径≥0.8 cm作为转移淋巴结诊断标准,对于短径<0.8 cm的淋巴结运用直径比≥0.7作为诊断转移的标准,诊断效能有了明显的提高,敏感度为83.8%,特异度为82.9%,约登指数为0.67。以淋巴结有"环形强化"或"边缘模糊"征象作为诊断标准的阳性预测值分别为62.2%、89.4%。结论用较小的短径作为转移淋巴结的诊断标准,能提高诊断效能;直径比有助于提高CT术前诊断转移淋巴结的价值;边缘模糊、环形强化可作为诊断转移淋巴结的参考标准。Objective To study the morphological criteria of lymph node metastasis in esophageal cancer with recon- structed images by multi-slice spiral CT （MSCT）. Method The MSCT MPR images of 208 cases of esophageal cancer confirmed pathologically were characterized retrospectively. Lymph nodes were considered as round if the diameter ratio （long axis/short axis） 1〉0.7. Internal lymph node structures such as characteristics of ring enhancement, cluster, or blurred margins were also evaluated and compared for respective diagnostic value. Result With a short-axis dimension ~〉1.0 cm as the metastasis definition, the sensitivity, specificity and Youden index were 23.6%, 98.6% and 0.22 respectively; when lymph nodes with a short axis dimension t〉0.8 cm was defined, and for those with a short axis 〈0.8 cm, an diameter ra- tio 〉/0.7 was defined as metastases, the sensitivity, specificity and Youden index were 83.8%, 82.9% and 0.67, respective- ly, besides, an obvious increase in diagnostic efficiency was observed. The positive predictive value （PPV） was 62.2% and 89.4% based on signs of blurred margin or ring enhancement as the metastasis definition, respectively. Conclusion The diagnostic efficiency of MSCT in esophageal cancer lymph node metastasis can be improved if shorter axis dimen- sion criteria is applied, and diameter ratio is also helpful to improve the diagnostic value of CT preoperative diagnosis of metastasis lymph nodes; Furthermore, the signs of blurred margin, and ring enhancement can be reference markers for diagnosis of lymph nodes metastasis.

关 键 词：食管癌 MSCT 转移淋巴结 直径比 

分 类 号：R735.1[医药卫生—肿瘤]