摘要
目的探讨多层螺旋CT（MSCT）增强扫描对胰腺癌术前肿瘤分期、淋巴结转移、血管浸润及神经浸润的诊断价值。方法收集自2013年1月至2015年12月在哈尔滨医科大学附属第二医院行MSCT增强扫描并在2周内经手术病理确诊为胰腺癌的患者87例，回顾性分析MSCT图像，评估肿瘤分期、淋巴结转移、血管浸润情况，并与术后病理比较。使用kappa检验、受试者工作特征（ROC）曲线分析等统计学方法评价MSCT增强扫描对胰腺癌的诊断价值。结果MSCT增强扫描对胰腺癌T分期的整体正确率为85.1%，kappa值为0.67（P〈0.01），T1、T2、T3、T4分期准确率分别为75.0%、57.1%、95.0%、66.7%；敏感度分别为75.0%、80.0%、87.7%、75.0%；特异度分别为98.8%、92.2%、86.4%、96.2%；阳性预测值分别为75.0%、57.1%、95.0%、66.7%；阴性预测值分别为98.8%、97.3%、70.4%、97.4%。MSCT增强扫描对淋巴结转移诊断的准确率、敏感度、特异度、阳性预测值和阴性预测值分别为62.1%、62.3%、61.5%、79.2%和41.0%。MSCT增强扫描对血管浸润的诊断准确性、敏感度、特异度、阳性预测值、阴性预测值分别为94.3%、78.6%、97.3%、84.6%和95.9%。MSCT增强扫描对神经浸润的诊断准确性、敏感度、特异度、阳性预测值、阴性预测值分别为80.5%、81.1%、76.9%、95.2%和41.7%；曲线下面积（AUC）为0.79（P＝0.001，95%CI0.68～0.90）。结论MSCT增强扫描对于胰腺癌肿瘤分期、神经浸润、血管浸润的术前诊断具有重要价值，但对于淋巴结转移诊断效果较差。
ObjectiveTo analyze the diagnostic value of multi-slice spiral computed tomography （MSCT） in preoperative tumor staging, lymphatic metastasis, vascular invasion and perineural invasion.
MethodsFrom January 2013 to December 2015, MSCT images of 87 patients from the Second Hospital of Harbin Medical University who were examined by contrast-enhanced MSCT and diagnosed as pancreatic cancer by surgical pathology within 2 weeks were collected.MSCT images were retrospectively analyzed to evaluate the tumor staging, lymphatic metastasis, vascular invasion and perineural invasion and then compared with surgical pathology.Kappa test and receiver operation characteristic （ROC） curve were used to evaluate the diagnostic value of MSCT in pancreatic cancer.
ResultsThe overall accuracy of MSCT in T staging of pancreatic cancer was 85.1% （kappa =0.67, P〈0.01）; the accuracy of T1, T2, T3 and T4 staging were 75.0%, 57.1%, 95.0% and 66.7%; the sensitivity were 75.0%, 80.0%, 87.7% and 75.0%; the specificity were 98.8%, 92.2%, 86.4% and 96.2%; the positive predictive value （PPV） were 75.0%, 57.1%, 95.0% and 66.7%; the negative predictive value （NPV） were 98.8%, 97.3%, 70.4% and 97.4%.The accuracy, sensitivity, specificity, PPV and NPV of MSCT in diagnosing lymphatic metastasis were 62.1%, 62.3%, 61.5%, 79.2% and 41.0%.The accuracy, sensitivity, specificity, PPV and NPV of MSCT in diagnosing vascular invasion were 94.3%, 78.6%, 97.3%, 84.6% and 95.9%.The accuracy, sensitivity, specificity, PPV and NPV of MSCT in diagnosing MSCT perineural invasion were 80.5%, 81.1%, 76.9%, 95.2% and 41.7%.The area under curve （AUC） was 0.79（95%CI 0.68-0.90, P=0.001）.
ConclusionContrast-enhanced MSCT plays important roles in evaluation of preoperative tumor staging, vascular invasion and perineural invasion of pancreatic cancer while it has little value on diagnosis of lymphatic metastasis.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第11期838-842,共5页
National Medical Journal of China
基金
国家“十二五”科技支撑计划（2015BAl01809）
国家自然科学基金（81471736）
黑龙江省留学基金（LC2013C38）
关键词
胰腺肿瘤
体层摄影术
肿瘤分期
Pancreatic neoplasms
Tomography
Neoplasm staging
作者简介
通信作者：姜慧杰，Email：jhjemail@163．com
