MSCT联合食管造影对食管破裂的诊断价值  

Diagnostic value of multi-slice spiral CT and esophagography in esophageal rupture

作　　者：刘彩云[1,2] 李绍东[1] 张秀莉[1] 徐凯[1] 苗新中[2] LIU Cai-yun LI Shao-dong ZHANG Xiu-li et al(Department of Radiology, the Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002,China)

机构地区：[1]徐州医学院附属医院影像科,江苏221002 [2]徐州医学院附属第三医院影像科,江苏221000

出　　处：《放射学实践》2016年第11期1052-1056,共5页Radiologic Practice

基　　金：徐州市2015年度科技计划项目(KC15SH058);徐州市2015年度科技情报项目(XKQ066)

摘　　要：目的:对比分析MSCT和食管造影对纵隔气肿患者食管破裂的诊断价值。方法:回顾性搜集同期(7天内)行MSCT和食管造影检查的68例纵隔气肿患者的病例资料。其中包括食管破裂患者19例,无食管破裂患者49例。由两名有经验的放射科医师(医师1和医师2)分别独立分析MSCT和食管造影图像特征,并对诊断信心予以评分。采用Kappa检验评价两名医师诊断食管破裂的一致性,利用相关样本Wilcoxon秩和检验分析评分的差异。以胃镜和随访结果为金标准,采用ROC评价MSCT和食管造影的诊断效能。结果:两名医师采用MSCT、食管造影诊断食管破裂均具有较好的一致性,Kappa值分别为0.713、0.816,P值均<0.05。两名医师采用MSCT诊断食管破裂的信心均超过食管造影,差异均有统计学意义(Z值分别为-3.317、-4.627,P值均﹤0.05)。医师1和医师2采用MSCT图像诊断食管破裂的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)、符合率、ROC下面积(Az)分别为100%、91.8%、82.6%、100%、94.1%、0.959和100%、95.9%、90.5%、100%、97.1%、0.980;采用食管造影分别为78.9%、100%、100%、92.5%、94.1%、0.895和84.2%、100%、100%、94.2%、95.6%、0.921。结论:联合应用MSCT和食管造影图像可全面诊断食管破裂及其并发症,明显提高诊断效能。Objective：To compare the value of MSCT and esophagography in the diagnosis of esophageal rupture in patients with pneumo-mediastinum. Methods：The clinical materials of sixty-eight patients with pneumomediastinum who underwent MSCT and esophagography （within 7d） were enrolled,including 19 patients with esophageal rupture and 49 patients without. Images were reviewed by two experienced radiologists （reader 1 and reader 2） independently. A five-point scale was performed to evaluate diagnostic confidence of esophageal rupture. Kappa analysis was performed to assess interobserver consistency of the two readers. Wilcoxon rank sum test was used to assess the difference of diagnostic confidence level. ROC was used to evaluate the diagnostic efficiency of CT and esophagography. Results：The reliability of the two readers between MSCT and esophagography results was good （kappa = 0. 713,0. 816, P〈 0.05, respectively）. The diagnostic confidence of MSCT for the diagnosis of esophageal rupture was significantly higher than that of esophagography for both reader 1 and reader 2 （Z= - 3. 317, - 4. 627, P^0.05, respectively）. The sensitivity, specificity, positive predictive value, negative predictive value,accuracy,and area under the alternative-free response ROC （AUC） for reader 1 and reader 2 were 100%,91.8%,82. 6%,100%,94. 1%,0. 959 and 100%,95. 9%,90. 5%,100%,97. 1%,0. 980 respectively by using MSCT,78.9% ,100% ,100%,92.5% ,94. 1%,0. 895 and 84.2% ,100% ,100% ,94.2% ,95.6%,0. 921 respectively by u- sing esophagography. Couelusiou：MSCT in combination with esophagography can significantly improve the diagnostic per formance for esophageal rupture in patients with pneumomediastinum.

关 键 词：食管破裂 体层摄影术 X线计算机 食管造影 

分 类 号：R57[医药卫生—消化系统] R816.4[医药卫生—内科学]