CT鉴别胃平滑肌瘤与胃神经鞘瘤的价值分析  

The value of CT for differentiating gastric leiomyoma from gastric schwannoma

作　　者：赵鲁平 李文豪[2] 刘乔璐 毛森[3] 陈月芹[1] 于昊 王唯伟 孙占国[1] Zhao Luping;Li Wenhao;Liu Qiaolu;Mao Sen;Chen Yueqin;Yu Hao;Wang Weiwei;Sun Zhanguo(Department of Medical Imaging,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Rehabilitation Medicine,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Ultrasound,the Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院医学影像科,济宁272000 [2]济宁医学院附属医院康复医学科,济宁272000 [3]济宁医学院附属医院超声科,济宁272000

出　　处：《中国医师进修杂志》2023年第3期241-246,共6页Chinese Journal of Postgraduates of Medicine

基　　金：山东省医药卫生科技发展计划项目(202009011151);2022年济宁市重点研发计划项目(2022YXNS033)。

摘　　要：目的探讨CT鉴别胃平滑肌瘤(GLM)与胃神经鞘瘤(GS)的价值。方法回顾性分析42例GLM患者(GLM组)和41例GS患者(GS组)的临床及影像资料,比较两组患者的一般资料及CT特征,采用多因素Logistic回归分析筛选鉴别GLM与GS的独立因素。受试者工作特征(ROC)曲线用于评估模型的诊断效能。结果GLM组女性比例和年龄明显低于GS组[59.52%(25/42)比85.37%(35/41)、(51.83±10.52)岁比(58.80±10.63)岁],差异有统计学意义(P<0.01)。GLM组发生胃上部率、形态不规则率、腔内型率、长短径比值和轻中度强化率明显高于GS组[71.43%(30/42)比14.63%(6/41)、52.38%(22/42)比21.95%(9/41)、92.86%(39/42)比19.51%(8/41)、1.90±0.55比1.34±0.28和92.86%(39/42)比51.22%(21/41)],囊变率、溃疡率、肿瘤相关淋巴结发生率及静脉期和延迟期CT值明显低于GS组[2.38%(1/42)比26.83%(11/41)、7.14%(3/42)比24.39%(10/41)、2.38%(1/42)比60.98%(25/41)、(59.21±9.75)HU比(66.22±10.33)HU和(65.02±8.62)HU比(76.85±11.89)HU],差异有统计学意义(P<0.01或<0.05);两组钙化率及平扫和动脉期CT值比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,发生部位、生长方式、肿瘤相关淋巴结和长短径比值是鉴别GLM与GS的独立因素(OR=34.385、25.314、0.023和97.700,95%CI 2.848~415.171、2.674~239.670、0.001~0.637和3.113~3066.549,P<0.01或<0.05);当模型阈值>0.647时,该模型的AUC为0.988(95%CI 0.934~1.000),灵敏度为92.9%,特异度为97.6%。结论当肿瘤发生于胃上部、呈腔内型生长、长短径比值>1.28并少见肿瘤相关淋巴结时倾向于GLM,相反则倾向于GS;因此,CT影像特征术前鉴别GLM与GS有一定的价值。Objective To evaluate the value of CT for differentiating gastric leiomyoma(GLM)from gastric schwannoma(GS).Methods The clinical and imaging data of 42 patients with GLM(GLM group)and 41 patients with GS(GS group)were analyzed retrospectively.The general information and CT features were compared between two groups.The independent factors for differentiating GLM from GS were obtained by multivariate Logistic regression analysis.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficiency of the model.Results The proportion of female and age in GLM group were significantly lower than those in GS group:59.52%(25/42)vs.85.37%(35/41),(51.83±10.52)years old vs.(58.80±10.63)years old,and there were statistical differences(P<0.01).The upper part of the stomach rate,irregular shape rate,intraluminal growth rate,ratio of long diameter to short diameter and mild to moderate enhancement rate in GLM group were significantly higher than those in GS group:71.43%(30/42)vs.14.63%(6/41),52.38%(22/42)vs.21.95%(9/41),92.86%(39/42)vs.19.51%(8/41),1.90±0.55 vs.1.34±0.28 and 92.86%(39/42)vs.51.22%(21/41),the cystic degeneration rate,ulcer rate,incidence of tumor-associated lymph node,CT values of venous phase and delayed phase in GLM group were significantly lower than those in GS group:2.38%(1/42)vs.26.83%(11/41),7.14%(3/42)vs.24.39%(10/41),2.38%(1/42)vs.60.98%(25/41),(59.21±9.75)HU vs.(66.22±10.33)HU and(65.02±8.62)HU vs.(76.85±11.89)HU,and there were statistical differences(P<0.01 or<0.05);there were no statistical difference in the rate of calcification and the CT values of plain scan and arterial phase between the two groups(P>0.05).Multivariate Logistic regression analysis result showed that the tumor location,growth mode,tumor-associated lymph node and ratio of long diameter to short diameter were the independent factors for differentiating GLM from GS(OR=34.385,25.314,0.023 and 97.700;95%CI 2.848 to 415.171,2.674 to 239.670,0.001 to 0.637 and 3.113 to 3066.549;P<0.01 or<0.05);when the m

关 键 词：胃 平滑肌瘤 神经鞘瘤 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]