| 许小伟,熊雷,游长金,等.多排螺旋 CT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):939-943. |
| 多排螺旋 CT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 |
| Application value of imaging features and multi-parameter measurement of MSCT in differentiating tumor deposition from metastatic lymph nodes in colorectal cancer |
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| DOI：10.3969/j.issn.1009-6469.2024.05.019 |
| 中文关键词: 结直肠肿瘤 肿瘤侵润 体层摄影术，螺旋计算机 鉴别诊断 肿瘤沉积 转移性淋巴结 |
| 英文关键词: Colorectal neoplasms Neoplasm invasiveness Tomography,spiral computed Differential diagnosis Tumor deposi-tion Metastatic lymph nodes |
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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 2018年 1月至 2022年 4月湖南省直中医医院 87例经病理学检查确诊的 CRC病人临床资料，其中 CT检查发现且病理证实的 TD病灶 45例为 A组、转移性淋巴结 42例为 B组，比较两组影像特征及 CT参数的差异，采用受试者操作特征( ROC)曲线分析各 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%)(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±0.41)cm均大于 B组( 0.98±0.35)cm、(0.77±0.33)cm、(0.95±0.38)cm(P<0.001)； A组长 -短径比(1.09±0.05)小于 B组( 1.28±0.18)(t=8.06，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)(P<0.001)； ROC曲线分析显示，形态不规则( AUC=0.72)、边缘模糊( AUC=0.65)、分叶征( AUC=0.68)、毛刺征( AUC=0.68)是鉴别 TD与转移性淋巴结的重要因素( P<0.05)； 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=0.79)以及平扫 CT值( AUC=0.82)、动脉期强化 CT值( AUC=0.89)、静脉期强化 CT值( AUC=0.86)诊断 TD的效能较佳(均 P<0.001)。通过 logistic回归将形态、边缘、分叶征、毛刺征，各 MSCT测量值进行计算后得出联合预测值， AUC为 0.98，灵敏度为 95.6%、特异度为 100.0%。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 The clinical da-ta of 87 patients with CRC confirmed by pathological examination in Hunan Provincial Hospital of Traditional Chinese Medicine fromJanuary 2018 to April 2022 were retrospectively analyzed. Among them, 45 patients with pathological and confirmed TD lesions foundby CT examination were in group A, and 42 patients with metastatic lymph nodes were in group B. Imaging features and parameter val-ues between the 2 groups were comapred,and ROC curve was used to analyze the efficiency of CT signs and parameter values in TD di.agnosis.Results The detection rate of irregular shape,fuzzy boundary, lobulation sign, spiculation sign in A group (73.02%, 60.32%,57.14%, 54.84%) were higher than those in B group(29.51%, 31.15%, 21.31%, 18.03%) (P<0.001); The longest diameter(1.33±0.38)cm, short diameter(1.21±0.31)cm and maximum diameter(1.29±0.41)cm 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(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)( P<0.001); the plain CT value (28.84±5.03),arterial phase enhancement value(32.85±6.93) and venous phase enhancementvalue (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)( P<0.001); ROC curve analy-sis showed that irregular shape(AUC=0.72),fuzzy boundary(AUC=0.65), lobulation sign (AUC=0.68),spiculation sign (AUC=0.68) wereimportant factors in differentiating TD from metastatic lymph nodes(P<0.051);multiple parameters of CT were important factors in dif-ferentiating TD from metastatic lymph nodes, in which, long-short diameter ratio (AUC=0.79), plain CT value(AUC=0.82), arterialphase enhancement value(AUC=0.89), venous phase enhancement value(AUC=0.86) were more effective(all P<0.001).Logistic regres-sion was used to calculate the morphology, edge, lobulation, burr and other MSCT measurements to obtain the combined predictive val-ue. ROC analysis showed that AUC was 0.98, sensitivity was 95.6%, and specificity was 100.0%.Conclusion The CT imaging fea-tures of TD are 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 have better diagnostic efficacy for TD. |
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