CT对胸部孤立性纤维瘤良恶性的诊断及鉴别诊断  

CT evaluation of benign and malignant thoracic solitary fibrous tumor

作　　者：陈智杰[1] 王寿扬[1] 叶永胜[1] 黎剑宇[1] 林晓锋[1] 陈淮[1] 

机构地区：[1]广州医科大学附属第一医院放射科,510120

出　　处：《实用医学影像杂志》2016年第2期125-128,共4页Journal of Practical Medical Imaging

摘　　要：目的分析胸部良恶性孤立性纤维瘤CT表现,探讨鉴别其良恶性的CT征象。方法回顾性分析经病理证实的26例良性、12例恶性胸部孤立性纤维瘤的CT特点,其中包括蒂、出血、钙化、胸腔游离性积液、不均匀强化、渐进性强化、边界清晰、对邻近结构的侵犯等。用秩和检验判断良恶性孤立性纤维瘤(SFT)最大径的差异是否具有统计学意义,最后使用ROC曲线评价最大径诊断良恶性SFT的准确性。结果对本组38例良恶性SFT最大径进行秩和检验,差异有统计学意义(P=0.024 5)。ROC曲线分析最大径预测SFT良恶性的曲线下面积为0.724 4。以最大径=9.3 cm为界值,诊断良恶性SFT的灵敏度为58%,特异度为85%,阳性似然比为3.791 7,阴性似然比为0.492 4。除了不均匀强化(P=0.030)和周围侵犯(P=0.007)差异有统计学意义外,其他因素,差异无统计学意义(P均>0.05)。结论当胸部SFT的CT表现有一定特征性,当出现最大径>9.3cm、不均匀强化、周围侵犯有助于良恶性的评估。Objective To analyze and discuss the CT features of benign and malignant thoracic solitary fibrous tumor （SFT）. Methods CT findings of 26 benign and 12 malignant thoracic SFTs proved by pathology, including the pedicel, hemorrhage, calcification, pleural effusion, inhomogeneous enhancement, progressive enhancement, clearer boundaries and invasion of adjacent structures were retrospectively analyzed. Using the rank-sum-test to find whether the difference between the maximum diameter of benign and malignant SFTs was statistically significant or not. Use the ROC curve to evaluate the maximum diameter on the accuracy of the diagnosis of the benign and malignant SFF, and identify the best critical point, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, then calculate the area under the ROC curve. Results The maximum diameters of 38 cases of benign and malignant SFTs were analyzed by using the rank-sum-test ,P=0.0245 ,showing significant statistical difference （P〈0.05）. Using the maximum diameter to predict the benign and malignant lesions and the area under the ROC curve was 0.724 4. As the critical point of the maximum diameter was 9.3 cm, the sensitivity, specificity, positive likelihood ratio and nega- tive likelihood ratio of diagnosing the optimum were respectively 58%, 85%, 3.791 7 and 0.492 4. The differences of inhomogeneous enhancement （P=-0.030） and invasion of adjacent structures （P=-0.007） were showing significant statisti- cal difference. Other factors had no statistical difference （P〉0.05）. Conclusion Above all, it contributes to evaluate the benign and malignant thoracic SFTs when the CT findings show some characteristics, such as maximum diameter greater than 9.3 cm, inhomogeneous enhancement, or invasion of adjacent structures.

关 键 词：孤立性纤维瘤 胸膜 胸部肿瘤 体层摄影术 螺旋计算机 

分 类 号：R730.44[医药卫生—肿瘤] R730.262[医药卫生—临床医学]