胃原发胃肠道间质瘤危险度分级的CT评估  

Evaluation of Contrast-Enhanced CT in Predicting Risk Grade of Primary Gastric Gastrointestinal Stromal Tumor

作　　者：吴佳美 刘梦奇[1] 周印 李庆姝[2] 张静 毛芸[1] WU Jiamei;LIU Mengqi;ZHOU Yin;LI Qingshu;ZHANG Jing;MAO Yun(Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;不详)

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016 [2]重庆医科大学基础医学院病理教研室,重庆400016 [3]重庆市巴南区第二人民医院放射科,重庆400054

出　　处：《中国医学影像学杂志》2022年第4期378-383,共6页Chinese Journal of Medical Imaging

基　　金：重庆市教委科技项目青年项目(KJQN201900423)。

摘　　要：目的探讨增强CT中不同部位胃原发胃肠道间质瘤(GIST)的形态学定性和定量指标对胃原发GIST术前危险度评估的分类价值。资料与方法回顾性选取2011年9月—2020年10月重庆医科大学附属第一医院193例具有完整术前CT增强扫描图像的胃原发GIST病灶,根据危险度分级将病灶分为高风险组和低风险组,按照原发病灶部位分为胃底、胃体、胃窦组。分析3个部位组增强CT中胃原发GIST形态学定性(生长方式、轮廓、边界、有无破裂、坏死或囊变、溃疡、钙化、肿大淋巴结、器官侵犯、粗大血管征、强化方式以及强化均匀度)和定量指标[①病灶CT值,包括平扫(CT_(N))、动脉期(CT_(A))、静脉期(CT_(V))、延迟期(CT_(D))、增强峰期(CT_(max))、动脉期绝对增强值(CT_(A-N))、静脉期绝对增强值(CT_(V-N))、延迟期绝对增强值(CT_(D-N))、静脉期同平扫的比值(CT_(V/N))以及延迟期同静脉期的比值(CT_(D/V))。②病灶形状:角A、角B、角C、角D、最长径(DAB)、肿瘤形状角度比值(SAR)],绘制受试者工作特征曲线确定风险预测模型的诊断效能。结果胃底组在边缘(χ^(2)=12.604)、坏死或囊变(χ^(2)=8.408)、强化均匀性(χ^(2)=7.300)、粗大血管征(χ^(2)=17.741)、Ki-67(χ^(2)=5.995)、DAB(U=241.500)、角B(U=762.500)、角C(U=950.000)、角D(U=899.000)方面,高风险组与低风险组差异有统计学意义(P均<0.05);胃体组在边界(χ^(2)=4.940)、坏死或囊变(χ^(2)=13.862)、强化均匀性(χ^(2)=14.238)、粗大血管征(χ^(2)=13.862)、DAB(U=119.00)、角A(U=448.500)、角C(U=313.500)方面,两组间差异有统计学意义(P均<0.05);胃窦组在DAB(t=4.549)、CTN(t=4.102)方面,两组间差异有统计学意义(P均<0.05)。纳入各高风险组的独立预测因子后,3组的二元Logistic回归方程模型的曲线下面积分别为胃底组0.905(95%CI 0.844~0.966)、胃体组0.875(95%CI 0.794~0.956)、胃窦组0.869(95%CI 0.688~1.000)。结论本研究针对不同发�Purpose To investigate the morphological qualitative and quantitative features of primary gastric gastrointestinal stromal tumor(GIST)at different sites of stomach measured by contrast-enhanced CT in the preoperative risk prediction.Materials and Methods A total of 193 lesions of primary gastric GIST with complete preoperative contrast-enhanced CT imaging in the First Affiliated Hospital of Chongqing Medical University from September 2011 to October 2020 were retrospectively included.All lesions were divided into three groups,including the low-risk group,high-risk group,and three location groups(fundus group,corpus group and antrum group).The morphological qualitative and quantitative features of preoperative contrast-enhanced CT images of primary gastric GIST among three groups were retrospectively analyzed by univariate logistic analysis(growth pattern,shape,margins,presence of rupture,necrosis or cystic degeneration,ulcer,calcification,enlarged lymph nodes,organ invasion,enlarged vessels,enhancement pattern,and enhancement uniformity)and multivariate logistic analysis(1.CT values of lesions:including nonenhanced phase(C_(TN)),arterial phase(C_(TA)),venous phase(C_(TV)),delayed phase(C_(TD)),peak phase of enhancement(CT_(max)),absolute enhancement value in arterial phase(CTA-N),absolute enhancement value in venous phase(CT_(V-N)),absolute enhancement value in delayed phase(CTD-N),ratio of venous phase to nonenhanced phase(CT_(V/N))and ratio of delayed phase to venous phase(CT_(D/V)).2.Lesion shape:angle A,angle B,angle C,angle D,longest diameter(D_(AB)),tumor shape angle ratio(SAR),and the diagnostic efficacy of the risk prediction model was determined via the receiver operator characteristic curve.Results There were statistically significant differences in gastric fundus margin(χ^(2)=12.604),necrosis or cystic degeneration (χ^(2)=8.408), enhancement uniformity (χ^(2)=7.300), gross vascular sign (χ^(2)=17.741), Ki-67 (χ^(2)=5.995), DAB (U=241.500), angle B (U=762.500), angle C (U=950.000), angle D (U=899.0

关 键 词：胃肠道间质瘤 体层摄影术 X线计算机 危险度分级 预测模型 

分 类 号：R735[医药卫生—肿瘤] R445.3[医药卫生—临床医学]