多层螺旋CT动态增强扫描在宫颈癌初诊中的价值及漏诊的影响因素分析  

Value of dynamic enhanced multi-slice spiral CT scan in primary diagnosis of cervical cancer and influencing factors for its missed diagnosis

作　　者：杨小霞[1] 张红芸[2] 李国晖[3] 李乐 苏红春 王烨 高瑾 吴爱辉 YANG Xiao-xia;ZHANG Hong-yun;LI Guo-hui;LI Le;SU Hong-chun;WANG Ye;GAO Jin;WU Ai-hui(Department of Oncology,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021,China;Department of Gynecology,First Affiliated Hospital of Kunming Medical University,Kunming 650021,China;Department of Radiology,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021,China;Department of Obstetrics and Gynecology,Kunming Third People's Hospital,Kunming 650041,China)

机构地区：[1]云南省中医医院肿瘤科,昆明650021 [2]昆明医科大学第一附属医院妇科,昆明650021 [3]云南省中医医院放射科,昆明650021 [4]昆明市第三人民医院妇产科,昆明650041

出　　处：《医疗卫生装备》2021年第6期65-68,共4页Chinese Medical Equipment Journal

基　　金：国家自然科学基金资助项目(81761128006);云南省科技计划项目(2017FE468(-050))。

摘　　要：目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)动态增强扫描在宫颈癌初诊中的价值及漏诊的影响因素。方法:回顾性分析287例初诊并行手术治疗的宫颈癌患者的临床资料,统计患者术前MSCT检查的结果,观察宫颈癌的MSCT表现,以术后病理检查为金标准,计算MSCT的漏诊率并综合患者临床资料分析漏诊影响因素。采用SPSS 26.0软件对数据进行统计学分析,单因素分析采用χ^(2)检验,多因素分析采用多因素Logistic回归分析。结果:MSCT平扫时宫颈癌病变与子宫正常组织分界不清,增强后动脉期呈不均匀明显强化,实质期强化程度较之前减退,延迟期强化程度明显减退。外生性宫颈癌表现为结节状或不规则分叶状改变,增强后呈轻度强化,并多合并无强化的囊变、坏死区;内生性宫颈癌表现为肿瘤向宫颈管管壁深层浸润,平扫时密度不均匀,增强后呈轻度强化。287例宫颈癌患者中,MSCT诊断准确率为74.6%、漏诊率为25.4%。单因素分析结果显示,肿瘤有无累及腺体、淋巴结有无发生转移、肿瘤最大直径以及肌层浸润深度可能为漏诊的相关因素(P<0.05);多因素Logistic回归分析结果显示,肌层浸润深度≤1/2为MSCT漏诊的独立影响因素(P<0.01)。结论:MSCT对浸润性宫颈癌的诊断效果较好,可清楚显示病变及侵犯范围,但对于肿瘤肌层浸润深度≤1/2的肿瘤可能出现漏诊,应结合其他辅助检查进行诊断。Objective To explore the value of dynamic enhanced multi-slice spiral CT(MSCT)in the primary diagnosis of cervical cancer and to analyze the influencing factors of its missed diagnosis.Methods The clinical data of 287 patients with cervical cancer who were first diagnosed and treated surgically were retrospectively analyzed,the results of the patients'preoperative MSCT examinations were summarized,the MSCT manifestations of cervical cancer were observed,and the postoperative pathological examination results were used as the gold standard to determine the rate of missed diagnosis of MSCT and to explore the factors influencing missed diagnosis by combining the patients'clinical data.(SPSS 26.0 software,χ^(2) test and multi-factor Logistic regression analysis were applied to statistical analysis,univariate analysis and multi-factor analysis,respectively).Results Plain scan showed the lesion was poorly demarcated from normal uterine tissue.Enhanced scan found uneven and marked enhancement in the arterial phase,comparatively reduced enhancement in the parenchymal phase and significantly relieved enhancement in the delayed phase.For exophytic cervical cancer nodular or irregular lobular changes were found with mild enhancement,and was often combined with non-enhancing cystic lesions and necrotic areas;for endophytic cervical cancer deep infiltration of the tumor into the wall of the cervical canal was shown with uneven density by plain scan and mild enhancement by enhanced scan.The 287 patients had the diagnostic accuracy of MSCT being 74.6%and the rate of missed diagnosis being 25.4%.Univariate analysis proved that the factors associated with missed diagnosis included the involvement of tumor in the gland,the lymph node metastasis,the maximum diameter of the tumor and the depth of tumor infiltration(P<0.05);multi-factor Logistic regression analysis suggested that the depth of tumor infiltration not greater than 1/2 was an independent factor influencing missed diagnosis by MSCT(P<0.01).Conclusion MSCT can clearly demo

关 键 词：宫颈癌 多层螺旋CT 动态增强 漏诊 

分 类 号：R318[医药卫生—生物医学工程] R814.42[医药卫生—基础医学]