浙江临床医学
浙江臨床醫學
절강림상의학
ZHEJIANG CLINICAL MEDICAL JOURNAL
2013年
11期
1615-1617
,共3页
肾上腺瘤体%腺瘤%髓样脂肪瘤%体层摄影术%X线计算机%CT值
腎上腺瘤體%腺瘤%髓樣脂肪瘤%體層攝影術%X線計算機%CT值
신상선류체%선류%수양지방류%체층섭영술%X선계산궤%CT치
Adrenal neoplasms%Adenoma%Medullary lipoma%Tomography%X-ray computed
目的：使用4点法和3层法评价平扫最小CT值在肾上腺瘤体鉴别诊断中的价值。方法回顾分析肾上腺瘤体123例（129枚），分别采用4点及3层测量法，测量各点最小CT值，分析不同阈值下两种方法的敏感度，特异度，阳性预测值，准确度，制作ROC曲线。结果肾上腺瘤体123例（129枚），包括51枚腺瘤，15枚髓样脂肪瘤和其他瘤体63枚（42枚转移瘤，14枚嗜铬细胞瘤，4枚淋巴瘤，3枚皮质癌）。4点法中，以平均最小CT值≤0HU为阈值判断腺瘤（除外髓样脂肪瘤），敏感度、特异度、阳性预测值、准确度分别为90.2%、95.2%、93.9%、93.0%，ROC面积为0.961。3层法中，以平均最小值CT值≤-69.5HU为阈值判断髓样脂肪瘤，敏感度、特异度、阳性预测值、准确度分别为100%、96.1%、88.2%、97%，ROC面积为0.997。结论4点法平均最小CT值≤0HU和3层法中平均最小CT值≤-69.5HU分别对腺瘤与非腺瘤（除外髓样脂肪瘤）和腺瘤与髓样脂肪瘤的诊断具有指导作用，二者联合应用对于肾上腺瘤体的鉴别诊断具有重要价值。
目的：使用4點法和3層法評價平掃最小CT值在腎上腺瘤體鑒彆診斷中的價值。方法迴顧分析腎上腺瘤體123例（129枚），分彆採用4點及3層測量法，測量各點最小CT值，分析不同閾值下兩種方法的敏感度，特異度，暘性預測值，準確度，製作ROC麯線。結果腎上腺瘤體123例（129枚），包括51枚腺瘤，15枚髓樣脂肪瘤和其他瘤體63枚（42枚轉移瘤，14枚嗜鉻細胞瘤，4枚淋巴瘤，3枚皮質癌）。4點法中，以平均最小CT值≤0HU為閾值判斷腺瘤（除外髓樣脂肪瘤），敏感度、特異度、暘性預測值、準確度分彆為90.2%、95.2%、93.9%、93.0%，ROC麵積為0.961。3層法中，以平均最小值CT值≤-69.5HU為閾值判斷髓樣脂肪瘤，敏感度、特異度、暘性預測值、準確度分彆為100%、96.1%、88.2%、97%，ROC麵積為0.997。結論4點法平均最小CT值≤0HU和3層法中平均最小CT值≤-69.5HU分彆對腺瘤與非腺瘤（除外髓樣脂肪瘤）和腺瘤與髓樣脂肪瘤的診斷具有指導作用，二者聯閤應用對于腎上腺瘤體的鑒彆診斷具有重要價值。
목적：사용4점법화3층법평개평소최소CT치재신상선류체감별진단중적개치。방법회고분석신상선류체123례（129매），분별채용4점급3층측량법，측량각점최소CT치，분석불동역치하량충방법적민감도，특이도，양성예측치，준학도，제작ROC곡선。결과신상선류체123례（129매），포괄51매선류，15매수양지방류화기타류체63매（42매전이류，14매기락세포류，4매림파류，3매피질암）。4점법중，이평균최소CT치≤0HU위역치판단선류（제외수양지방류），민감도、특이도、양성예측치、준학도분별위90.2%、95.2%、93.9%、93.0%，ROC면적위0.961。3층법중，이평균최소치CT치≤-69.5HU위역치판단수양지방류，민감도、특이도、양성예측치、준학도분별위100%、96.1%、88.2%、97%，ROC면적위0.997。결론4점법평균최소CT치≤0HU화3층법중평균최소CT치≤-69.5HU분별대선류여비선류（제외수양지방류）화선류여수양지방류적진단구유지도작용，이자연합응용대우신상선류체적감별진단구유중요개치。
Objective To evaluate the value of the lowest mean attenuation measured with 4-point measurement and 3-slice measurements on plain CT in differential diagnosis of adrenal neoplasms. Methods 129 cases of adrenal lesions were enrolled into this study. All masses were measured with 4-point measurement and 3-slice measurement to get the lowest mean attenuation.The sensitivity,specificity,false positive rate and false negative rate,positive predictive value,negative predictive value,accuracy were analyzed on different thresholds,and ROC curves were made. Results The 129 cases of adrenal lesions included 51 cases of adenoma,15 cases of medullary lipoma and other 63 cases (including 42 patients with metastatic tumor,and 14 cases were pheochromocytoma,4 cases of lymphoma,3 cases of cortical carcinoma).Taking 0HU as the cutoff,the sensitivity,specific degree,positive predictive value and diagnostic accuracy were 90.2%,95.2%,93.9%, 93.0%by 4-point measurement to diagnose the mass that excluded medullary lipoma While they were100%、96.1%、88.2%、97%by 3-slice measurement to judge medullary lipoma by the cutoff at-70HU.Meanwhile the ROC curves were 0.961 and 0.997. Conclusion It is more easy to different adenoma from adrenal mass with the 4-point measurement while medullary lipoma with 3-slice measurement.And there is significant value on adrenal-lesion-diagnosis by simultaneously apply the two method.
