基于双瞬切能谱CT联合临床特征对肝硬化高危食管静脉曲张的预测价值  

Prediction of Hepatosplenic Hemodynamics Combined with Clinical Features Based on Dual-Energy CT for Esophageal Varices at High Risk of Cirrhosis

作　　者：陈洁文 黄伟康 杨丽洋 马昆 蔡婷婷 文戈[1] CHEN Jiewen;HUANG Weikang;YANG Liyang;MA Kun;CAI Tingting;WEN Ge(Department of Radiology,Zengcheng Branch of Nanfang Hospital,Southern Medical University,Guangzhou 511300,China;不详)

机构地区：[1]南方医科大学南方医院增城院区医学影像科,广东广州511300 [2]GE中国CT影像研究中心,广东广州510000

出　　处：《中国医学影像学杂志》2025年第3期292-297,共6页Chinese Journal of Medical Imaging

基　　金：“南医影像联盟”科研专项基金(FS202402003)。

摘　　要：目的探讨双瞬切能谱CT获得的肝脾血流动力学指标联合临床特征,无创评估肝硬化患者高危食管静脉曲张(EV的预测价值。资料与方法回顾性收集2022年3月—2023年5月南方医院增城院区肝硬化患者93例,患者均进行上腹部能谱CT增强及胃镜检查。根据胃镜评估的EV严重程度(无,EV0;轻,EV1;中,EV2;重,EV3)将患者分为低危EV(EV0、EV1)及高危EV(EV2、EV3)组。收集两组的年龄、性别、Child-Pugh分级、有无腹水、血小板,并测量能谱CT参数肝脏及脾脏体积、平均碘含量与碘容量。对两组参数的差异进行分析,使用Logistic回归分析构建模型,采用受试者工作特征曲线评估模型对高危EV的诊断性能。结果两组年龄、Child-Pugh分级、腹水、血小板、肝脏体积、脾脏体积、肝脏碘容量和脾脏碘容量差异有统计学意义(t/Z/χ^(2)值=-5.921~16.343,P<0.05)。将腹水、血小板、肝脏体积、脾脏体积、肝脏碘容量和脾脏碘容量纳入二元Logistic回归分析构建模型,结果显示脾脏碘容量(OR=1.002,P<0.001)、腹水(OR=5.319,P=0.009)、血小板(OR=0.990,P=0.062)是预测EV高风险的独立危险因子,Hosmer-Lemeshow检验表明该回归模型与观测值拟合良好(P=0.303),准确度为83.9%,敏感度为78.6%,特异度为88.2%,阳性预测值为84.6%,阴性预测值为83.3%,曲线下面积为0.894。结论基于双能CT的脾脏碘容量、血小板及腹水等指标能术前无创预测高危EV。Purpose To explore the predictive value of hepatosplenic hemodynamic indexes obtained by dual-energy CT combined with clinical features in non-invasive assessment of high-risk esophageal varices(EV)in cirrhosis.Materials and Methods We retrospectively collected 93 patients with cirrhosis from March 2022 to May 2023 in Zengcheng Branch of Nanfang Hospital.All patients underwent epigastric enhanced energy spectrum scan and gastroscopy.EV severity as assessed by gastroscopy(none,EV0;mild,EV1;medium,EV2;severe,EV3)were divided into low-risk EV group(EV0 and EV1)and high-risk EV group(EV2 and EV3).Age,gender,Child-Pugh grade,ascites and platelet of the two groups were collected,and dual-energy CT parameters including liver and spleen volume,mean iodine content in liver and spleen and liver and spleen iodine volume were measured.The difference of parameters between the low-risk EV and the high-risk EV group were analyzed,and the model was constructed by Logistic regression analysis.Receiver operating characteristic curve was used to evaluate the diagnostic performance of the model for high-risk EV.Results There were significant differences in age,Child-Pugh grade,ascites,platelet,liver and spleen volume,liver and spleen iodine volume between low-risk EV and high-risk EV groups(Z/χ^(2)=-5.921-16.343,all P<0.05).Ascites,platelet,liver and spleen volume,liver and spleen iodine volume were included in multivariate regression analysis to construct regression models,and the results showed that spleen iodine volume(OR=1.002,P<0.001),ascites(OR=5.319,P=0.009),platelet(OR=0.99,P=0.062)were independent risk factors for predicting the high risk of EV.Hosmer-Lemeshow test showed that the regression model fit the observed values well(P=0.303),with accuracy of 83.9%,sensitivity of 78.6%,specificity of 88.2%,positive prediction rate of 84.6%and negative prediction rate of 83.3%.The area under the curve of this regression model was 0.894.Conclusion Spleen iodine content based on dual-energy CT,platelet and ascites can noninvasively p

关 键 词：肝硬化 食管和胃静脉曲张 体层摄影术 X线计算机 血小板 腹水 预测 

分 类 号：R575.2[医药卫生—消化系统] R571.3[医药卫生—内科学] R445.3[医药卫生—临床医学] R442.5