CT纹理分析在量化胰腺囊腺瘤影像表型中的诊断价值  

Diagnostic value of CT texture analysis in the quantification of radiological phenotype for pancreatic cystadenoma

作　　者：胡征宇 沈起钧[2] 冯湛[3] 张亮[4] 万国仕 陈足廷 胡晓杰 罗超群 赵奋华 

机构地区：[1]余杭区第二人民医院放射科,杭州311121 [2]杭州市第一人民医院放射科 [3]浙江大学附属第一医院放射科 [4]浙江省肿瘤医院放射科 [5]东阳市人民医院放射科

出　　处：《中华胰腺病杂志》2017年第5期330-334,共5页Chinese Journal of Pancreatology

基　　金：浙江省医药卫生科技科研基金项目（2017KY051）;杭州市农业与社会发展科研项目（164519）

摘　　要：目的通过CT纹理分析量化胰腺囊腺瘤特殊的影像纹理，为胰腺囊性肿瘤的鉴别诊断提供客观的影像学依据。方法回顾性分析2009年1月至2016年12月间浙江大学附属第一医院放射科及杭州市第一人民医院放射科经病理证实的胰腺浆液性囊腺瘤48例和黏液性囊性肿瘤34例患者的胰腺增强CT图像。在增强CT扫描实质期5个断层图上根据肿瘤边界描画出感兴趣区域。从纹理细腻（σ＝1.0）到纹理粗糙（σ＝2.5）获得平均灰度强度、像素分布的方差、熵值、偏度和峰度等参数。对有统计学意义的纹理参数绘制受试者操作特征（ROC）曲线，计算ROC曲线下面积（AUC）及诊断敏感性、特异性。对高、低年资医师用传统CT征象分析方法诊断的准确性进行比较。结果2名放射科医师间测量信度系数为0.809～0.997，一致性非常高。与黏液性囊性肿瘤比较，浆液性囊腺瘤不同滤值时的偏度、滤值为2.5时的方差（5.93±9.02比1.29±0.62）、熵值（2.39±0.61比2.02±0.39）、峰度（30.18±42.55比8.80±4.34）差异均有统计学意义（P值均〈0.05），而其他值之间的差异均无统计学意义。有差异的参数诊断两类囊性肿瘤的AUC介于0.56～0.84之间。低年资医师和高年资医师用传统CT征象分析方法诊断的准确性分别为60%和71%。结论CT纹理分析不仅能有效地量化胰腺囊腺瘤的异质性，而且在鉴别诊断中也能发挥有效的作用。ObjectiveTo provide objective parameters for differentiating pancreatic cystic tumors via using computed tomography texture analysis （CTTA） to quantify the special imaging features of pancreatic cystadenomas.MethodsEnhanced CT images of pancreas from patients who were admitted in Department of Radiology in First Hospital affiliated with Zhejiang University and First People′s Hospital of Hangzhou City and pathologically diagnosed as pancreatic serous cystadenomas （n=48） and mucinous cystadenomas （n=34） from January 2009 to December 2016 were retrospectively analyzed. Regions of interest were drawn on the parenchymal phase CT images in 5 slices according to the border of the tumors. Mean grey level intensity （M）, variance （V）, entropy （E）, skewness （Ske） and kurtosis （Kur） were obtained from fine texture （σ=1.0） to coarse texture （σ=2.5）. Receiver operating characteristic （ROC） curve for texture parameters with statistically difference was drawn, and the area under curve （AUC）, diagnostic sensitivity and specificity were calculated. The diagnostic accuracy of senior and junior doctors was compared with the traditional CT analysis method.ResultsReliability coefficient of the two radiologists was 0.809~0.997 with high consistency. Compared with mucinous cystic tumors, serous cystadenomas had a significantly different V （5.93±9.02 vs 1.29±0.62）, E （2.39±0.61 vs 2.02±0.39） and Kur（30.18±42.55 vs 8.80±4.34） in Ske0 of 2.5 （P〈0.05）, and there were no statistically significant differences on other parameters. The AUC of differential parameters for diagnosing two kinds of cystic tumors ranged from 0.56 to 0.84.The diagnostic accuracy of the traditional CT analysis method by junior doctor and senior radiologist was 60% and 71%, respectively.ConclusionsCTTA can not only effectively quantify the heterogeneity of pancreatic cystadenomas, but also is effective in the differentiation.

关 键 词：胰腺 囊腺瘤 浆液 囊腺瘤 黏液 图像处理 计算机辅助 体层摄影术 螺旋 计算机 

分 类 号：R730.44[医药卫生—肿瘤] R735.9[医药卫生—临床医学]