计算机断层扫描仿真内窥镜成像技术对结直肠癌及其临床分期的诊断价值  

Diagnostic value of computed tomography virtual endoscope technique in colorectal cancer and its clinical staging

作　　者：于文东 张艳艳 薛瑶 许克宁 朱红江 李存瑞 赵春龙 殷少龙 唐建坡 Yu Wendong;Zhang Yanyan;Xue Yao;Xu Kening;Zhu Hongjiang;Li Cunrui;Zhao Chunlong;Yin Shaolong;Tang Jianpo(Department of Radiology,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China;Department of Vascular Surgery,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China;Department of GI Medicine,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China;Department of General Surgery,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China)

机构地区：[1]张家口市第一医院放射医学科,河北张家口075000 [2]张家口市第一医院血管外科,河北张家口075000 [3]张家口市第一医院消化内科,河北张家口075000 [4]张家口市第一医院普外科,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2022年第4期484-488,共5页Journal of Vascular and Endovascular Surgery

基　　金：张家口市科技计划项目(2021093D)。

摘　　要：目的探讨计算机断层扫描仿真内窥镜成像(CTVE)技术检查的微血管密度(MVD)在结直肠癌及其临床分期诊断中的应用价值。方法收集2017年1月至2021年12月张家口市第一医院收治的结直肠肿瘤患者的临床资料,所有患者均接受了CTVE检查。比较结直肠癌、结直肠良性肿瘤患者以及不同分期结直肠癌患者MVD的CTVE检查结果与病理学检查结果。以病理学检查结果为“金标准”,应用受试者工作特征(ROC)曲线分析术前采用CTVE检查MVD对结直肠癌的诊断价值,计算灵敏度、特异度、准确度等诊断效能指标,分析术前CTVE检查与病理学检查对结直肠癌及临床分期诊断结果的一致性。结果CTVE检查与病理学检查下结直肠良性肿瘤、结直肠癌患者的MVD比较,差异均无统计学意义(P>0.05)。不同TNM分期结肠癌患者MVD的病理学检查结果、CTVE检查结果比较,差异均有统计学意义(P<0.01)。ROC曲线分析结果显示,CTVE检查下MVD诊断结直肠癌的曲线下面积(AUC)为0.918(95%CI:0.848~0.988),当约登指数为0.796时cut-off值为9.420,此时灵敏度为94.74%,特异度为84.85%,准确度为91.11%,标准误为0.036,对结直肠癌具有较高的诊断价值(P<0.01)。术前CTVE检查诊断结直肠癌临床分期的Kappa值为0.936,与病理学检查结果具有高度一致性(P<0.01)。结论CTVE技术通过检查MVD对结直肠癌与结直肠良性肿瘤的诊断和鉴别具有一定的应用价值,可准确评估术前结直肠癌临床分期,且具有无创、重复性好等优势。Objective To investigate the application value of microvascular density(MVD)detected by computed tomography virtual endoscope(CTVE)in the diagnosis and clinical staging of colorectal cancer.Method Clinical data of patients with colorectal cancer admitted to Zhangjiakou First Hospital from January 2017 to December 2021 were collected and all patients received CTVE.The MVD diagnosed by CTVE and pathological examination of patients with colorectal cancer and colorectal benign tumors and the colorectal cancer patients with different stages was compared by using pathological results as the gold standard.MVD was examined by CTVE before operation,and the diagnostic value of MVD for colorectal cancer was analyzed by receiver operating characteristic(ROC)curve,and the diagnostic efficacy indexes including sensitivity,specificity and accuracy.The diagnostic consistency of preoperative CTVE with pathological examination in diagnosing colorectal cancer and the clinical stage was analyzed.Result There was no significant difference in MVD between CTVE and pathological examination of colorectal benign tumor and colon cancer(P>0.05).There were significant differences for MVD detected by CTVE and pathological examination of colorectal cancer with different TNM stages(P<0.01).ROC curve showed the area under the curve(AUC)of MVD in diagnosing colorectal cancer under CTVE was 0.918(95%CI:0.848-0.988).When the Youden index was 0.796,the cut-off value was 9.420,and the sensitivity,specificity,accuracy and standard error was 94.74%,84.85%,91.11%and 0.036,which showed diagnostic value(P<0.01).Kappa value of preoperative CTVE in diagnosing clinical staging of colorectal cancer was 0.936,with high consistency with pathological examination(P<0.01).Conclusion CTVE has diagnostic value in diagnosing and identifying colorectal cancer and colorectal benign tumors by detecting MVD,which can be used to evaluate clinical staging of preoperative colorectal cancer with the advantages of non-invasion and good repeatability.

关 键 词：计算机断层扫描仿真内窥镜成像 结直肠癌 微血管密度 临床分期 诊断价值 

分 类 号：R543.7[医药卫生—心血管疾病]