光谱CT鉴别胃肠道异位胰腺与间质瘤的价值  

Value of spectral CT in differential diagnosis of gastrointestinal heterotopic pancreas and stromal tumor

作　　者：黄河 李丹[3] 王金花 李红兵 李德福[3] 刘于宝 HUANG He;LI Dan;WANG Jinhua;LI Hongbin;LI Defu;LIU Yubao(Medical Imaging Center,Shenzhen Hospital of Southern Medical University,Guangdong 518101,China;Southern Medical University Third School of Clinical Medicine,Guangdong 510515,China)

机构地区：[1]南方医科大学深圳医院医学影像中心,广东深圳518101 [2]南方医科大学第三临床医学院,广东广州510515 [3]深圳市宝安区福永人民医院放射科,广东深圳518101

出　　处：《影像诊断与介入放射学》2024年第3期178-184,共7页Diagnostic Imaging & Interventional Radiology

基　　金：深圳市科技创新委员会基础研究面上项目(JCYJ20210324125403011、JCYJ20230807142308018)

摘　　要：目的探讨双层探测器光谱CT(DLCT)多参数成像对胃肠道异位胰腺(HP)及间质瘤(GIST)的鉴别诊断价值。方法回顾性分析经术后病理证实胃肠道HP及GIST患者的临床及DLCT影像资料,分别在动脉期和静脉期图像上测量胃肠道HP与GIST的碘浓度(IC)、有效原子序数(Zeff)。对所有的光谱CT参数进行单因素、二元Logistic回归分析筛选出预测因子,采用受试者工作特征(ROC)曲线分析其诊断效能。结果男21例,女26例,其中胃肠道HP 22例,中位年龄43(38.7,50.5)岁;GIST 25例,中位年龄57(50.5,67)岁。单因素分析显示,动静脉期IC值、Zeff值均具有统计学差异(P<0.05)。二元Logistic回归分析显示静脉期IC值、动脉期Zeff值为HP的独立预测因子,P值分别为0.008、0.013。ROC曲线显示两者能量参数区分HP和GIST的曲线下面积分别为0.792和0.786,敏感度分别为72.7%和68.2%,特异度为88%和92%,最佳阈值为2.065 mg/mL、8.295。结论DLCT的IC值、Zeff值对有效区分HP与GIST具有一定诊断意义,当静脉期IC值大于等于2.065 mg/mL,动脉期Zeff值大于等于8.295时模型诊断HP性能最佳。Objective To assess the value of dual-layer detector spectral CT(DLCT)multi-parameter imaging in the differential diagnosis of gastrointestinal heterotopic pancreas(HP)and gastrointestinal stromal tumor(GIST).Methods The clinical and DLCT imaging data of 47 patients(21 men and 26 women)with pathologically confirmed gastrointestinal HP and GIST were analyzed retrospectively.The iodine concentration(IC)and effective atomic number(Zeff)of gastrointestinal HP and GIST were measured in the arterial and venous phases.The predictive factors were screened out by univariate and binary logistic regression analysis of all spectral CT parameters,and the diagnostic efficiency was analyzed by receiver operating characteristic(ROC)curve.Results There were 22 gastrointestinal HP patients with median age of 43 years(range:38.7-50.5 years)and 25 GIST patients with median age of 57 years.Univariate analysis showed that the values of IC and Zeff in arteriovenous phase were statistically different(P<0.05).Binary logistic regression analysis showed that venous phase IC value(P=0.008)and arterial phase Zeff value(P=0.013)were independent predictors of HP.The area under the ROC curve(AUC)of 2.065 mg/mL venous phase IC threshold value was 0.792 with 72.7%sensitivity and 88.0%specificity compared to AUC of 0.786 of 8.295 arterial phase Zeff threshold value with 68.2%sensitivity and 92.0%specificity for distinguishing HP from GIST.Conclusion The venous phase IC value and Zeff value of DLCT can effectively distinguish HP from GIST.

关 键 词：异位胰腺 胃肠道间质瘤 光谱CT 参数 鉴别诊断 

分 类 号：R576[医药卫生—消化系统] R735.2[医药卫生—内科学] R735.3[医药卫生—临床医学] R814.42