CT特征及临床指标对儿童肝母细胞瘤诊断的价值  

The value of clinical and CT features in preoperative diagnosis of hepatoblastoma

作　　者：张龚巍[1] 黎耀文 张欢[2] 孟宪磊[1] 莫东霞 徐焕丽[3] 李钱程 干芸根[1] 赵彩蕾[1] ZHANG Gongwei;LI Yaowen;ZHANG Huan;MENG Xianlei;MO Dongxia;XU Huanli;LI Qiancheng;GAN Yungen;ZHAO Cailei(Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, P.R.China;Department of Pathology, Shenzhen Children's Hospital, Shenzhen 518038, P.R.China;Department of Hematological Oncology, Shenzhen Children's Hospital, Shenzhen 518038, P.R.China;Department of Radiology, Xuzhou Children's Hospitl, Xuzhou 221006, P.R.China)

机构地区：[1]广东省深圳市儿童医院放射科,广东深圳518038 [2]广东省深圳市儿童医院病理科,广东深圳518038 [3]广东省深圳市儿童医院血液肿瘤科,广东深圳518038 [4]江苏省徐州市儿童医院放射科,江苏徐州221006

出　　处：《医学影像学杂志》2021年第12期2065-2070,共6页Journal of Medical Imaging

基　　金：广东省深圳市医疗卫生三名工程项目资助(编号:SZSM202011005)。

摘　　要：目的探讨肝母细胞瘤(HB)的临床指标及CT特征对术前肿瘤定性诊断的价值。方法选取有完整临床资料及术前CT图像的113例肝脏占位病变的患儿信息,将患儿分为HB组(62例)和非HB组(51例),术前均行腹部CT平扫及三期增强扫描。观察一般临床指标与病变的CT征象,采用Mann-Whitney检验和皮尔逊卡方检验比较组间指标的差异,对差异有统计学意义的临床指标及CT征象进行二元logistic回归分析,得到与HB组相关的联合预测因素(模型1);对差异有统计学意义的CT征象单独纳入二元logistic回归方程,得到与HB组相关的独立预测因素(模型2)。采用受试者工作特征曲线(ROC)评价两预测模型的诊断效能。结果患儿年龄≤5岁、AFP增高、血小板增高、病灶最大径、囊变坏死、分隔、假包膜、动脉期强化特点、廓清及肝内或远处转移的组间差异均有统计学意义(P<0.05)。Logistic回归分析显示,模型1中年龄≤5岁、假包膜及动脉期强化特点是HB组的危险因素;ROC曲线确定病灶最大径临界值为63 mm,曲线下面积为0.84[95%可信区间(0.76,0.90)];模型2显示,病灶假包膜及动脉期强化特点是HB组的危险因素。模型1和模型2的ROC曲线下面积分别为0.98[95%可信区间(0.94,0.99)]、0.94[95%可信区间(0.88,0.98)],诊断敏感度和特异度分别为93.55%、100%和91.94%、92.16%。结论当肝内病灶最大径超过63 mm,增强CT动脉期表现为呈外周分布为主的结节状、岛屿状或梁索状高强化,门静脉期或延迟期可见假包膜,结合患儿年龄≤5岁,可高度提示为HB;术前通过增强CT检查即可较为精准地对HB做出定性诊断。Objective To investigate the value of the clinical and CT features of hepatoblastoma(HB)in the diagnosis of preoperative tumors.Methods Clinical data and CT findings of 113 cases with space occupying lesions of liver were retrospectively analyzed.All cases were divided into HB(62 cases)and non-HB group(51 cases).Abdominal non-enhanced and three phases contrast-enhanced scanning were performed before surgery.The general clinical indicators and CT signs of the lesion were observed and statistically analyzed.Mann-Whitney test and Pearson's chi-square test were used to compare the differences between groups,and binary logistic regression analysis was performed on clinical and CT signs with statistically significant differences between the groups,thus the combined predictive factors related to the HB group were obtained(model 1).CT signs with statistically significant differences were separately incorporated into the binary logistic regression equation to obtain independent predictors related to the Hb group(Model 2).Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficacy of the two predictive models.Results There were statistically significant differences in the age≤5 years,AFP increase and platelet increase between HB and non-HB group(P<0.05).There were statistically significant differences between HB and non-HB group in maximum diameter of the lesion,cystic necrosis,separation,pseudocapsule,arterial phase enhancement,washout and intrahepatic or distant metastasis(P<0.05).Logistic regression analysis showed that the age≤5 years,arterial phase enhancement and pseudocapsule were the risk factors for HB group.The cut-off value of maximum diameter of the lesion was 63 mm,and the area under the curve was 0.8495%confidence interval(0.76,0.90).The area under the ROC curve of combined clinical indicators and CT signs features was 0.9895%confidence interval(0.94,0.99),and the area under the ROC curve of CT features was 0.9495%confidence interval(0.88,0.98).The diagnostic sensitivity and s

关 键 词：肝母细胞瘤 体层摄影术 X线计算机 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]