CT轴位扫描结合多平面重建成像对老年肠穿孔患者术前诊断的价值分析  

Clinical value of CT axial scan combined with multiplanar reconstruction imaging in preoperative diagnosis of elderly patients with intestinal perforation

作　　者：冯波 朱翰林 张梅花 Feng Bo;Zhu Hanlin;Zhang Meihua(Department of Radiology,Dajiangdong Hospital,Hangzhou,Zhejiang 311225,China)

机构地区：[1]杭州市大江东医院放射科,311225

出　　处：《中国基层医药》2019年第22期2721-2724,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨CT轴位扫描结合多平面重建(MPR)成像应用于老年肠穿孔患者术前诊断的价值.方法选取2017年3月至2019年3月杭州市大江东医院收治的老年疑似肠穿孔患者127例,患者均于术前行CT轴位扫描,并行MPR.按照研究的要求,1位医师独立分析CT轴扫图像,另1位医师独立分析CT轴扫结合MPR图像.计算CT轴扫分析的阳性率,以及CT轴扫结合MPR图像分析的阳性率.以手术病理诊断为金标准,比较CT轴扫分析阳性率与真实穿孔率、CT轴扫结合MPR图像分析阳性率与真实穿孔率、以及CT轴扫分析的阳性率与CT轴扫结合MPR图像分析的阳性率.另外,以手术病理诊断为金标准,分别计算这两种诊断方法的阳性预测值、阴性预测值、灵敏度、特异度和准确率.结果127例老年疑似肠穿孔患者中,通过CT轴扫分析,发现肠穿孔并准确定位者86例,阳性率为67.72%,采用CT轴扫结合MPR图像分析,发现肠穿孔并准确定位者113例,阳性率为88.98%.最终,经手术病理诊断证实为肠穿孔的患者为119例,占93.70%.CT轴扫分析阳性率与手术病理诊断穿孔率的差异有统计学意义(67.72%比93.70%,χ^2=27.537,P<0.001).CT轴扫结合MPR图像分析阳性率与手术病理诊断穿孔率的差异无统计学意义(88.98%比93.70%,χ^2=1.792,P=0.181).CT轴扫分析的阳性率为67.72%,CT轴扫结合MPR图像分析的阳性率为88.98%,差异有统计学意义(χ^2=16.918,P<0.001).CT轴扫分析相对于手术病理检查的阳性预测率为95.35%,阴性预测率为9.76%,灵敏度为68.91%,特异度为50.00%,准确率为67.72%.CT轴扫结合MPR图像分析相对于手术病理检查的阳性预测率为99.12%,阴性预测率为50.00%,灵敏度为94.12%,特异度为87.50%%,准确率为93.70%.结论将CT轴位扫描与MPR相结合,可提高老年肠穿孔患者术前诊断的准确性.Objective To evaluate the clinical value of CT axial scan combined with multiplanar reconstruction(MPR)imaging in preoperative diagnosis of elderly patients with intestinal perforation.Methods From March 2017 to March 2019,127 patients with suspected intestinal perforation in Dajiangdong Hospital were enrolled.The patients were examined by CT axial scan and MPR,119 patients confirmed intestinal perforation by postoperative pathological diagnosis.According to the requirements of this study,one radiologist analyzed the CT axial scan image independently,and the other analyzed the CT axial scan combined with the MPR image also.The positive rate of CT axial scan analysis and the positive rate of CT axial scan combined with MPR image analysis were calculated.The pathological diagnosis was used as the gold standard,the positive rate of CT axial scan and the real perforation rate were compared,the positive rate of CT axial scan combined with MPR and the real perforation rate were compared,the positive rates of CT axial scan and CT axial scan combined with MPR were compared.The positive predictive values,negative predictive values,sensitivity,specificity and accuracy of CT axial scan and CT axial scan combined with MPR were calculated.Results Of 127 patients with suspected intestinal perforation,86 cases were diagnosed and located by CT axial scan,with the positive rate 67.72%,113 cases were diagnosed and located by CT axial scan and MPR,with the positive rate 88.98%.Finally,119 cases were confirmed by pathological diagnosis,with the positive rate 93.70%.The difference between the positive rate of CT axial scan and the perforation rate of pathological diagnosis was statistically significant(67.72%vs.93.70%,χ^2=27.537,P<0.001).There was no statistically significant difference between the positive rate of CT axial scan combined with MPR and the perforation rate of pathological diagnosis(88.98%vs.93.70%,χ^2=1.792,P=0.181).The positive rate of CT axial scan was 67.72%,and the positive rate of CT axial scan combined with MPR

关 键 词：肠穿孔 CT轴位扫描 多平面重建 阳性预测值 阴性预测值 灵敏度 特异度准确率 老年人 

分 类 号：R73[医药卫生—肿瘤]