MSCT在腹膜结核与腹膜癌鉴别诊断中的价值  

Value of MSCT in differential diagnosis of peritoneal tuberculosis and peritoneal carcinoma

作　　者：徐冬[1] 孙小丽[2] 徐泽璇 李兴鹏 王仁贵[2] 侯代伦 XU Dong;SUN Xiaolie;XU Zexuan;LI Xingpeng;WANG Rengui;HOU Dailun(Department of Radiology,Bejing Chest Hospital,Capital Medical University,Beijing 101149,China;Department of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,Chin)

机构地区：[1]首都医科大学附属北京胸科医院放射科,北京101149 [2]首都医科大学附属北京世纪坛医院放射科,北京100038

出　　处：《医学影像学杂志》2023年第5期813-817,共5页Journal of Medical Imaging

基　　金：北京市通州区高层次人才发展支持计划领军人才基金项目(编号:YHLD2019029);首都医科大学附属北京世纪坛医院青年基金项目(编号:2020-q18)。

摘　　要：目的通过对比分析腹膜结核与腹膜癌的MSCT征象,探讨MSCT在腹膜结核与腹膜癌鉴别诊断中的价值。方法选取我院腹膜结核组40例和腹膜癌组51例患者的临床及影像学资料。所有患者均行腹部MSCT平扫及增强扫描。CT观察内容:壁腹膜厚度、形态及强化特征,网膜改变,肠系膜改变,腹腔淋巴结改变,腹腔积液密度及分布,特殊CT征象(大网膜边缘征、扇贝征等)。对腹膜结核组和腹膜癌组的MSCT表现按不同影像学征象进行分类,计数资料采用χ^(2)检验,计量资料采用均数±标准差表示,P<0.05为差异有统计学意义;采用多元逻辑回归计算大网膜边缘征、淋巴结钙化及淋巴结环形强化诊断腹膜结核的敏感度、特异度、阳性预测值和阴性预测值。结果腹膜结核组与腹膜癌组的MSCT征象中,壁腹膜结节样及肿块样增厚、大网膜饼样增厚及边缘征、淋巴结钙化及环形强化和扇贝征,两组间差异有统计学意义(P<0.05);大网膜边缘征、淋巴结钙化及环形强化诊断腹膜结核的敏感度分别为17.5%、17.5%、15.0%,特异度分别为100%、98.4%、100%,阳性预测值分别为100%、87.5%、100%,阴性预测值分别为60.7%、60.2%、60.0%。结论腹膜结核及腹膜癌的MSCT征象有重叠,极易混淆,而大网膜边缘征、淋巴结钙化及环形强化诊断腹膜结核有较高的特异度和阳性预测值,有助于两种疾病的鉴别。Objective To explore the value of MSCT in the differential diagnosis of peritoneal tuberculosis and peritoneal carcinoma by comparing and to analyze the MSCT signs of peritoneal tuberculosis and peritoneal carcinoma. Methods The clinical and imaging data of 40 patients with peritoneal tuberculosis and 51 patients with peritoneal carcinoma in our hospital were collected. All patients underwent plain and enhanced abdominal MSCT scanning. CT observation contents were as follows: thickness, morphology and enhancement characteristics of parietal peritoneum, omental changes, mesenteric changes, abdominal lymph node changes, density and distribution of peritoneal effusion, and special CT signs(omental marginal sign, scallop sign et al). The MSCT findings of peritoneal tuberculosis group and peritoneal carcinoma group were classified according to different imaging signs. The counting data were validated by Chi square test, and the measurement data were expressed by mean ± standard deviation, P<0.05, represented statistically significant;Sensitivity, specificity, positive predictive value and negative predictive value of omental marginal sign, lymph node calcification and lymph node ring enhancement were calculated by multiple logistic regression. Results In the MSCT signs of peritoneal tuberculosis group and peritoneal carcinoma group, there were significant differences between the two groups(P<0.05), including parietal peritoneal nodule and mass thickening, greater omentum cake thickening and marginal signs, lymph node calcification and ring strengthening and scallop signs. The sensitivity of omental margin sign, lymph node calcification and ring enhancement in the diagnosis of peritoneal tuberculosis were 17.5%, 17.5% and 15.0%, the specificity were 100%, 98.4% and 100%, the positive predictive values were 100%, 87.5% and 100%, and the negative predictive values were 60.7%, 60.2% and 60.0%, respectively. Conclusion The MSCT signs of peritoneal tuberculosis and peritoneal carcinoma overlap are easy to be confused. The

关 键 词：腹膜结核 腹膜癌 鉴别诊断 体层摄影术 X线计算机 

分 类 号：R735.5[医药卫生—肿瘤] R814.42[医药卫生—临床医学]