多层螺旋CT的肿瘤优势供血动脉征对胰胃间隙外生型肿瘤的定位诊断价值  

The value of multi-slice CT-based tumor predominant feeding artery sign in the localization diagnosis of exophytic tumors in the pancreaticogastric space

作　　者：李英[1] 唐磊[1] 付佳[1] 李晓婷[1] 李子禹[2] 孙应实[1] Li Ying;Tang Lei;Fu Jia;Li Xiaoting;Li Ziyu;Sun Yingshi(Department of Radiology, Peking University Cancer Hospital & Institute,Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education,Beijing 100142,China;Department of Gastrointestinal Surgery,Peking University Cancer Hospital & Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所医学影像科恶性肿瘤发病机制及转化研究教育部重点实验室,100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠外科,100142

出　　处：《中华放射学杂志》2019年第7期564-568,共5页Chinese Journal of Radiology

基　　金：首都临床特色应用研究(Z161100000516060);北京市医院管理局重点医学专业发展计划(ZYLX201803).

摘　　要：目的探讨多层螺旋CT上的肿瘤优势供血动脉征对胰胃间隙外生型肿瘤的定位诊断价值。方法回顾性分析2013年1月至2016年4月北京大学肿瘤医院行多层螺旋CT检查,且经病理证实的胰胃间隙外生型肿瘤患者34例,其中胃胃肠间质瘤(GIST)20例,胰腺肿瘤14例,其中7例为胰腺神经内分泌肿瘤(NEN),7例胰腺实性假乳头状瘤(SPN)。识别肿瘤的供血动脉并做出定位诊断,观察肿瘤优势供血动脉征。采用χ2检验或Fisher精确检验比较胃GIST和胰腺肿瘤患者供血动脉及肿瘤优势供血动脉征显示的差异,分别计算肿瘤优势供血动脉征对胃GIST和胰腺肿瘤定位诊断的效能。结果20例胃GIST中有19例、14例胰腺肿瘤中有13例CT能够显示肿瘤供血动脉,GIST和胰腺肿瘤在肿瘤起源血管上的差异有统计学意义(χ2=23.86,P<0.01),GIST多起源于胃动脉系统,胰腺肿瘤则多起源于脾动脉胰腺分支。17例胃GIST(17/20,85.0%)和11例胰腺肿瘤(11/14,78.6%)肿瘤优势供血动脉征阳性,差异无统计学意义(P=1.000)。将所有34例患者纳入分析,肿瘤优势供血动脉征诊断胃GIST的敏感度、特异度、诊断准确度、阳性预测值和阴性预测值分别为85.0%(17/20)、92.9%(13/14)、88.2%(30/34)、94.4%(17/18)、81.3%(13/16),诊断胰腺肿瘤的上述效能指标分别为71.4%(10/14)、100.0%(20/20)、88.2%(30/34)、100.0%(10/10)、83.3%(20/24)。结论多层螺旋CT肿瘤优势供血动脉征可辅助胰胃间隙胃及胰腺外生性肿瘤的定位诊断。Objective To evaluate the value of multi-slice CT-based tumor predominant feeding artery sign in the localization diagnosis of exophytic tumors in the pancreaticogastric space. Methods CT images of 34 patients with pathologically proven exophytic tumors located in the pancreaticogastric space including 20 gastric gastrointestinal stromal tumors (GIST) and 14 pancreatic tumors,7 patients of neuroendocrine neoplasms (NEN) and 7 patients of solid pseudopapillary neoplasms (SPN) were retrospectively analyzed. Two radiologists identified the tumor feeding arteries of the tumors and made the localization diagnoses. The inter-observer agreement was evaluated by Kappa coefficient. Chi-square test or Fisher exact test was used to compare the visualization of tumor predominant feeding artery sign in the two groups. Results The tumor feeding arteries were identified in 19 of 20 gastric GISTs and 13 of 14 pancreatic tumors. The two observers had a good agreement on the origins of the tumor feeding arteries(Kappa coefficient: 0.681). There was statistically significant difference in the origins of the tumor feeding arteries between the two groups (χ2=23.86,P<0.01). The blood supplies of most GISTs originated from gastric arteries, while those of most pancreatic tumors originated from the pancreatic branch of splenic artery. The tumor predominant feeding artery sign was identified in 17 gastric GISTs (17/20, 85.0%) and 11 pancreatic tumors (11/14, 78.6%). There was no statistically significant difference in the positive rate of the sign between the two groups (P=1.000). For all tumors enrolled, the sensitivities, specificities, accuracies, positive predictive values, and negative predictive values of the sign for the localization diagnosis of gastric GISTs and pancreatic tumors were 85.0%(17/20), 92.9%(13/14), 88.2%(30/34), 94.4%(17/18), 81.3%(13/16) and 71.4%(10/14), 100.0%(20/20), 88.2%(30/34), 100.0%(10/10), 83.3%(20/24), respectively. Conclusion The tumor predominant feeding artery sign on multi-slice CT can assist in the

关 键 词：胃肠间质瘤 胰腺肿瘤 体层摄影术 X线计算机 

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