CT对脾脏占位性病变良恶性的诊断价值  

The diagnostic value of CT in splenic benign and malignant masses

作　　者：祝琼洁 严陈晨[1] 何健[1] ZHU Qiongjie;YAN Chenchen;HE Jian(Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院医学影像科,江苏南京210008

出　　处：《实用放射学杂志》2021年第7期1113-1117,共5页Journal of Practical Radiology

摘　　要：目的 探讨鉴别脾脏占位性病变良恶性的CT征象及临床指标.方法 回顾性分析80例经病理明确诊断的脾脏占位性病变的CT征象及临床表现.评估CT征象,包括:病灶数目、大小、边缘、性质、钙化情况、增强表现、脾脏有无肿大、是否有肿大淋巴结及有无积液(胸、腹或盆腔).评估临床数据,包括:年龄、性别、症状及病史.采用多因素Logistic回归分析,明确脾脏恶性占位性病变的重要预测因素.采用受试者工作特征(ROC)曲线评价诊断效能.结果 脾脏恶性占位性病变多发生于有恶性肿瘤病史或有新发恶性肿瘤的老年患者,男性居多(11/17,64.7%).恶性CT征象表现为多发、边缘模糊不清的实性肿块,肿块增强呈等或低强化、脾脏肿大、淋巴结肿大及有积液(胸、腹或盆腔)(P<0.05).其中肿大淋巴结[优势比(OR)=61.068;95%置信区间(CI)8.435~442.130;P=0.000]、有恶性肿瘤病史或有新发恶性肿瘤(OR=58.792;95%CI 5.422~637.486;P=0.001)是预测恶性病变的重要指标,两指标相结合对脾脏恶性占位性病变的诊断有较好的特异性(92.1%)和准确性(90.0%).结论 病灶数目、边缘、性质、增强表现、脾脏大小、淋巴结大小、是否出现积液(胸、腹或盆腔)及患者年龄、性别、症状及病史对于鉴别脾脏占位性病变良恶性有意义,其中淋巴结肿大、有恶性肿瘤病史或有新发恶性肿瘤是脾脏恶性占位性病变的重要预测因素.Objective To investigate the CT findings and clinical manifestations of benign and malignant splenic masses to improve the differential diagnosis.Methods The CT findings and clinical features of 80 cases with splenic masses confirmed by pathology were analyzed retrospectively.Assessed some CT features including the number,size,margin,pathological type,calcification,and enhancement degree of lesions,the size of spleen and lymph node,and the effusion in chest,abdomen or pelvic cavity.Also assessed some clinical data,including the age,sex,symptom and medical history.Multivariate Logistic regression analysis was performed to identify the important predictors of malignant splenic masses.Used receiver operating characteristic(ROC)curve analysis for evaluation of diagnostic performance.Results Splenic malignant masses mostly occurred in elderly patients with a history of malignancy or new malignant tumor,especially in males(11/17,64.7%).Malignant CT signs were manifested as multiple solid masses with ill-defined margin,hypoenhancement or isoenhancement degree,splenomegaly,enlarged lymph node and effusion in chest,abdomen and pelvic cavity(P<0.05) Among them,enlarged lymph node[odds ratio(OR)=61.068;95% confidence interval(CI)8.435-442.130;P=0.000],presence of history of malignancy or new malignant tumor(OR=58.792;95%Cl 5.422-637.486;P=0.001)were significant predictors for malignancy.The combination of enlarged lymph node and presence of history of malignancy or new malignant tumor had a good specificity(92.1%)and accuracy(90.0%)in the diagnosis of splenic malignant masses.Conclusion The number,margin,pathological type,enhancement degree of lesions,the size of spleen and lymph node,presence of effusion or not in chest,abdomen and pelvic cavity,the age,sex,sympjtom and medical history are significant for differentiating benign lesions from malignant ones of spleen,among which the enlarged lymph node and presence of history of malignancy or new malignant tumor are important predictors of splenic malignant lesions.

关 键 词：脾脏占位性病变 计算机体层成像 

分 类 号：R551.1[医药卫生—血液循环系统疾病] R814.42[医药卫生—内科学]