CT和CTA评价四肢软组织肉瘤血管与骨侵犯的价值  

Value of preoperative CT and CTA in the evaluation of vascular and osseous invasion by soft-tissue sarcoma in extremities

作　　者：李鹍[1] 马焕[1] 李振辉[1] 陶海波[1] 丁莹莹[1] LI Kun;MA Huan;LI Zhen-hui;TAO Hai-bo;DING Ying-ying(Department of Radiology, Third Affiliated Hospital of Kunming Medical University ,Kunming 650018 ,P. R. China)

机构地区：[1]昆明医科大学第三附属医院.云南省肿瘤医院放射科,云南昆明650018

出　　处：《中华肿瘤防治杂志》2017年第22期1594-1599,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的准确判断软组织肉瘤(soft tissue sarcoma,STS)病灶与邻近大血管及骨的关系是规范化手术切除的重要保障。本研究旨在探讨术前常规CT断面及CT血管造影(CT angiography,CTA)图像评价四肢STS对邻近大血管及骨侵犯情况的价值。方法收集云南省肿瘤医院2013-01-01—2016-06-30STS患者109例。男53例,女56例,年龄9~81岁,中位年龄49岁。在CT断面及CTA图像上对肿瘤与邻近大血管及骨的关系进行评分,以病理结果作为"金标准"进行诊断试验,计算CT断面及CTA图像评价STS累及血管、骨骼的敏感度、特异度,并进行比较。结果患者均选择手术治疗,其中行截肢术24例,根治性切除术16例,扩大切除术69例。病理确诊大血管受累27例,未受累82例;骨受侵20例,未受侵89例。CT断面和CTA图像诊断STS邻近大血管受累的最佳诊断值分别为4a型和1分,其中AUC分别为0.964、0.930,敏感性为81.48%和98.78%,特异性为96.30%和79.27%,进一步比较两者的诊断效能差异无统计学意义,z=1.178,P=0.238。CT诊断STS骨受累的敏感性为75.00%,特异性为96.63%。结论 CT断面及CTA图像诊断STS侵犯邻近大血管与骨的敏感性和特异性均较高,对外科STS术前分期、手术切缘评估及术式选择有重要价值。OBJECTIVE Accurate judgment of the relationship between soft tissue sarcoma and adjacent major vessels and bone is an important guarantee for standardized surgical resection.This study aims to explore the value of conventional CT images and CT angiography（CTA）in the evaluation of vascular and osseous invasion by soft-tissue sarcoma in extremities.METHODS In the Tumor Hospital of Yunnan Province,109 patients with soft tissue sarcoma were enrolled from January 01,2013 to June 30,2016.Among them,53 males and 56 females were aged from 9 to 81 years and the median age was 49 years.The relationship between tumor and adjacent major vessels and bone was scored on the CT images and CTA.The sensitivity and specificity of CT images and CTA were calculated with surgical records and pathologic results serving as the reference standard.RESULTS All patients underwent surgical treatment,including 24 cases of amputation,radical resection in 16 cases,69 cases of enlarged resection.Pathology confirmed 27 cases of vascular involvement and not affected in 82 cases,bone invasion in 20 cases and not invaded in 89 cases.Compared to the pathological findings,the best diagnostic threshold,AUC,sensitivity and specificity of CT images and CTA were type 3,1 points,0.964,0.930,81.48%,98.78% and 96.30%,79.27% respectively in the evaluation of vascular invasion by soft-tissue sarcoma in extremities.Diagnostic efficiency had no statistically significance between CT and CTA（Z=1.178,P=0.238）.The sensitivity and specificity of CT images in diagnosis of bone invasion were 75.00% and 96.63%,respectively.CONCLUSION CT images and CTA have high sensitivity and specificity in evaluating vascular and bone invasion of soft-tissue sarcoma in extremities,which is of great value in the preoperative staging,surgical margin assessment and choice of operation.

关 键 词：肢体 软组织肉瘤 计算机X线断层摄影术 CT血管成像 

分 类 号：R730.44[医药卫生—肿瘤] R738.6[医药卫生—临床医学]