基于CT影像特征构建鉴别胃神经鞘瘤与胃间质瘤的列线图模型  

A nomogram model for differentiating gastric schwannoma from gastric stromal tumor based on CT imaging features

作　　者：赵鲁平 陆浩然 王玉红[1] 徐景景[1] 孙占国[1] 陈月芹[1] 翁泽灿 毛森[4] Zhao Luping;Lu Haoran;Wang Yuhong;Xu Jingjing;Sun Zhanguo;Chen Yueqin;Weng Zecan;Mao Sen(Department of Medical Imaging,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Hepatobiliary Surgery,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Radiology,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Medicine 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肝胆外科,济宁2272000 [3]广东省人民医院放射科广东省医学科学院,广州510080 [4]济宁医学院附属医院超声医学科,济宁272000

出　　处：《中国医师进修杂志》2024年第7期624-630,共7页Chinese Journal of Postgraduates of Medicine

基　　金：2022年济宁市重点研发计划(2022YXNS033);2023年济宁市重点研发计划(软科学项目)(2023JNZC082)2023年济宁市重点研发计划(2023YXNS072)。

摘　　要：目的探讨基于CT影像特征构建术前鉴别诊断胃神经鞘瘤(GS)与胃间质瘤(GST)(长径2~5 cm)的列线图模型。方法回顾性分析2009年7月至2023年4月济宁医学院附属医院和2017年6月至2022年9月广东省人民医院49例GS患者和240例GST患者的临床和影像资料。采用多因素Logistic回归分析鉴别GS与GST的独立因素。采用R4.3.1软件构建鉴别GS和GST的列线图模型,绘制受试者工作特征(ROC)曲线,评估列线图模型鉴别GS与GST的效能;通过校准曲线和决策曲线评估列线图模型的预测效能和临床应用价值。结果GS患者和GST患者有临床症状率、钙化率、溃疡率、肿瘤血管率、长短径比值和动脉期与平扫CT值差值(CTV A-N)比较差异无统计学意义(P>0.05)。GS患者女性比例、发生于胃中下部率、混合或腔外型生长率、肿瘤相关淋巴结率、明显强化率、静脉期与平扫CT值差值(CTV P-N)、延迟期与平扫CT值差值(CTV D-N)、静脉期与动脉期CT值差值(CTV P-A)和延迟期与静脉期CT值差值(CTV D-P)明显高于GST患者[75.51%(37/49)比58.33%(140/240)、85.71%(42/49)比54.17%(130/240)、75.51%(37/49)比45.00%(108/240)、44.90%(22/49)比5.42%(13/240)、51.02%(25/49)比27.08%(65/240)、32.0(26.0,43.5)HU比29.0(22.0,37.7)HU、(44.59±13.46)HU比(32.94±12.47)HU、20.0(11.5,25.0)HU比10.0(5.0,17.0)HU和9.0(6.0,12.0)HU比4.0(-2.7,7.0)HU],年龄、形态不规则率、囊变率和不均匀强化率明显低于GST患者[(58.12±12.59)岁比(62.05±11.22)岁、16.33%(8/49)比38.33%(92/240)、18.37%(9/49)比51.25%(123/240)和34.69%(17/49)比56.25%(135/240)],差异有统计学意义(P<0.05或<0.01)。多因素Logistic回归分析结果显示,部位、囊变、肿瘤相关淋巴结、CTV P-A和CTV D-P是鉴别GS与GST的独立影响因素(OR=3.599、0.201、19.031、1.124和1.160,95%CI 1.184~10.938、0.070~0.578、6.159~58.809、1.066~1.185和1.094~1.231,P<0.05或<0.01)。基于部位、囊变、肿瘤相关淋巴结、CTV P-A和CTV D-P构建鉴别GSObjectiveTo construct a nomogram model for differentiating gastric schwannoma(GS)from gastric stromal tumor(GST)(diameters 2 to 5 cm)based on CT imaging features before surgery.MethodsThe clinical and imaging data of 49 patients with GS and 240 patients with GST in the Affiliated Hospital of Jining Medical University from July 2009 to April 2023 and Guangdong Provincial People′s Hospital from June 2017 to September 2022 were analyzed retrospectively.The independent factors for differentiating GS from GST were obtained by multivariate Logistic regression analysis.The nomogram model was constructed by R4.3.1 software.The efficacy of the nomogram model for differentiating GS from GST was evaluated by the receiver operating characteristics(ROC)curve,and calibration curve and decision curve analysis were used to evaluate the predictive efficacy and clinical application value of the nomogram model.ResultsThere were no statistical differences in the clinical symptom rate,calcification rate,ulcer rate,tumor vessel rate,ratio of long diameter to short diameter and CT value difference during the arterial and nonenhanced phases(CTV A-N)between GS patients and GST patients(P>0.05).The proportion of female,incidence of lesions located in central or lower part of stomach,extraluminal or mixed growth rate,tumor-associated lymph node rate,strong enhancement rate,CT value difference during the portal and nonenhanced phases(CTV P-N),CT value difference during the delayed and nonenhanced phases(CTV D-N),CT value difference during the portal and arterial phases(CTV P-A)and CT value difference during the delayed and portal phases(CTV D-P)in GS patients were significantly higher than those in GST patients:75.51%(37/49)vs.58.33%(140/240),85.71%(42/49)vs.54.17%(130/240),75.51%(37/49)vs.45.00%(108/240),44.90%(22/49)vs.5.42%(13/240),51.02%(25/49)vs.27.08%(65/240),32.0(26.0,43.5)HU vs.29.0(22.0,37.7)HU,(44.59±13.46)HU vs.(32.94±12.47)HU,20.0(11.5,25.0)HU vs.10.0(5.0,17.0)HU and 9.0(6.0,12.0)HU vs.4.0(-2.7,7.0)HU,the age,irregular shape

关 键 词：神经鞘瘤 胃 胃肠道间质肿瘤 体层摄影术 螺旋计算机 列线图 

分 类 号：R735.2[医药卫生—肿瘤]