| 许小伟.MSCT影像特征与多参数测量在鉴别结直肠癌肿瘤沉积与转移性淋巴结中的应用价值[J].安徽医药,2024,28(5):. |
| MSCT影像特征与多参数测量在鉴别结直肠癌肿瘤沉积与转移性淋巴结中的应用价值 |
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| 投稿时间：2022-07-13 录用日期：2022-09-03 |
| DOI： |
| 中文关键词: 体层摄影术 结直肠癌 鉴别诊断 肿瘤沉积 转移性淋巴结 |
| 英文关键词: |
| 基金项目: |
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| 摘要点击次数: 405 |
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| 中文摘要: |
| 目的探讨多排螺旋CT（MSCT）影像特征与多参数测量在鉴别结直肠癌（CRC）肿瘤沉积（TD）与转移性淋巴结中的应用价值。方法回顾性分析87例经病理学检查确诊的CRC患者临床资料，其中CT检查发现且病理证实的TD病灶63枚（45例）为A组、转移性淋巴结61枚（42例）为B组，由2名影像医师独立阅片，阅片结果采用Kappa系数进行一致性检验；采用χ2检验比较两组形态、边缘、密度、分叶征、毛刺征、坏死液化等特征差异；采用t检验比较两组长径、短径、最大径、长-短径比、平扫CT值、动脉期强化CT值、静脉期强化CT值差异；采用ROC曲线分析上述CT征象与参数值诊断TD的效能。结果A组形态不规则、边缘模糊、分叶征、毛刺征检出率（73.02%、60.32%、57.14%、54.84%）高于B组（29.51%、31.15%、21.31%、18.03%）（χ2=23.491，P＜0.001；χ2=10.617，P＜0.001；χ2=16.648，P＜0.001；χ2=17.310，P＜0.001；）；A组结节长径（1.33±0.38 cm）、短径（1.21±0.31 cm）、最大径（1.29±0.41cm）均大于B组（0.98±0.35 cm、0.77±0.33 cm、0.95±0.38 cm）（t=5.330，P＜0.001；t=7.655，P＜0.001；t=4.785，P=＜0.001）；A组长-短径比（1.09±0.05）小于B组（1.28±0.18）（t=8.064，P=＜0.001）；A组平扫CT值（28.84±5.03）、动脉期强化CT值（32.85±6.93）与静脉期强化CT值（51.36±8.94）均大于B组（16.82±4.68、19.19±5.38、39.74±7.75）（t=13.766，P=＜0.001；t=12.233，P=＜0.001；t=8.388，P=＜0.001）；ROC曲线分析显示，形态不规则（AUC=0.718）、边缘模糊（AUC=0.646）、分叶征（AUC=0.679）、毛刺征（AUC=0.680）是鉴别TD与转移性淋巴结的重要因素（P＜0.001，P=0.005，P=0.001，P=0.001）；CT多参数均是鉴别TD与转移性淋巴结的重要因素，其中长-短径比（AUC=0.793）以及平扫CT值（AUC=0.823）、动脉期强化CT值（AUC=0.890）、静脉期强化CT值（AUC=0.855）诊断TD的效能较佳（均P＜0.001）。结论TD的CT影像特征主要表现为形态不规则、边缘模糊、分叶征、毛刺征；MSCT各项参数中长-短径比以及平扫、动脉期、静脉期强化CT值对TD具有较佳的诊断效能。 |
| 英文摘要: |
| Objective.To investigate the application value of imaging features and multi-parameter measurement of multi-slice spiral CT(MSCT) in differentiating tumor deposition (TD) from metastatic lymph nodes in colorectal cancer (CRC).Methods: Clinical data of 87 patients with CRC confirmed by pathological examinationwere retrospectively analyzed,Among them, 63 TD lesions (45 cases) found by CT examination and confirmed by pathology were classified into group A and 61 metastatic lymph nodes (42 cases) were classified into group B. The films were reviewed by 2 radiologists independently, and the results were tested for consistency by Kappa coefficient; χ2test was used to compare the shape, margin,density, lobulation sign, spiculation sign, liquefaction necrosis between the 2 groups; T test was used to compare the difference of longest diameter, short diameter and maximum diameter,long - short diameter ratio, the plain CT value ,arterial phase enhancement value and venous phase enhancement value between the 2 groups; ROC curve was used to analyze the efficiency of CT signs and parameter values in TD diagnosis.Results:The detection rate of irregular shape,fuzzy boundary, lobulation sign, spiculation sign in A group(73.02%, 60.32%, 57.14%, 54.84%) was higher than that in B group(29.51%, 31.15%, 21.31%, 18.03%) (χ2=23.491,P＜0.001;χ2=10.617,P＜0.001;χ2=16.648,P＜0.001; χ2=17.310, P＜0.001); The longest diameter(1.33±0.38 cm), short diameter(1.21±0.31 cm) and maximum diameter(1.29±0.41cm) of nodules in A group were greater than those in B group(0.98±0.35 cm,0.77±0.33 cm, 0.95±0.38 cm)( t=5.330，P＜0.001；t=7.655，P＜0.001；t=4.785，P=＜0.001); long - short diameter ratio(1.28±0.18) in A group was smaller than that in B group(1.09±0.05)( t=8.064，P=＜0.001); the plain CT value(28.84±5.03) ,arterial phase enhancement value(32.85±6.93) and venous phase enhancement value (51.36±8.94) in A group were greater than those in B group(16.82±4.68, 19.19±5.38, 39.74±7.75)( t=13.766,P=＜0.001; t=12.233, P=＜0.001; t=8.388, P=＜0.001); ROC curve analysis showed that irregular shape(AUC=0.718),fuzzy boundary(AUC=0.646), lobulation sign(AUC=0.679),spiculation sign(AUC=0.680) were important factors in differentiating TD from metastatic lymph nodes(P＜0.001,P=0.005,P=0.001,P=0.001);multi-parameter measurement of CT were important factors in differentiating TD from metastatic lymph nodes, in which, long - short diameter ratio (AUC=0.793), plain CT value(AUC=0.823), arterial phase enhancement value(AUC=0.890), venous phase enhancement value(AUC=0.855) were more effective(all P＜0.001).（Conclusion:The imaging features of TD were irregular shape,fuzzy boundary, lobulation sign spiculation sign; Among multi-parameters, long-short diameter ratio, plain CT value ,arterial phase enhancement value and venous phase enhancement value had better diagnostic efficacy for TD. |
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