中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
8期
577-580
,共4页
蔡萍%杜明珊%李志超%石彦姝%杨景%王槐志%郭诗翔%王健
蔡萍%杜明珊%李誌超%石彥姝%楊景%王槐誌%郭詩翔%王健
채평%두명산%리지초%석언주%양경%왕괴지%곽시상%왕건
胰腺肿瘤%淋巴结转移%体层摄影术%X线计算机
胰腺腫瘤%淋巴結轉移%體層攝影術%X線計算機
이선종류%림파결전이%체층섭영술%X선계산궤
Pancreatic neoplasms%Lymph node metastasis%Computed tomography%X ray computer
目的 探讨双源CT检查对胰头癌淋巴结转移的诊断价值.方法 回顾性分析2007年12月至2009年12月第三军医大学西南医院收治的52例经病理检查结果证实的胰头癌患者的临床资料,所有患者行双源CT平扫和增强扫描,将CT图像上的淋巴结与病理标本比较,记录淋巴结的部位、数目,测量其短轴、长轴直径并计算各淋巴结的短长轴直径比,淋巴结的强化方式以及CT值的变化.分别以淋巴结短轴直径≥5、8、10 mm作为淋巴结发生转移的诊断标准,统计各种不同标准的敏感度、特异度、阳性预测值、阴性预测值及准确度.计量资料组间均数比较采用f检验,计数资料采用x2检验.结果 52例胰头癌患者淋巴结转移率为67.3％(35/52).切除标本中共检出163枚淋巴结,病理检查诊断其中118枚发生转移.第13组与第17组、第12组、第14组、第16组淋巴结转移率分别为80.0％ (28/35)、85.7％ (30/35)、97.1％(34/35)、20.0％(7/35).CT检查诊断环状强化的淋巴结转移率为100.0％(56/56),均匀强化的淋巴结转移率为71.0％(76/107),两者比较,差异有统计学意义(x2=18.198,P＜0.05).转移淋巴结CT值增加(25.0 ±3.3)HU,未转移淋巴结CT值增加(14.0±2.0)HU,两者比较,差异有统计学意义(=22.732,P＜0.05).转移淋巴结和未转移淋巴结的平均短轴直径、长轴直径、短长轴直径比分别比较,差异均有统计学意义(t=3.732,3.354,3.430,P＜0.05).分别以淋巴结短轴直径≥5、8、10 mm作为淋巴结发生转移的诊断标准,双源CT检查的敏感度分别为99.2％、43.2％和18.6％,特异度分别为22.2％、77.7％和88.9％,阳性预测值分别为77.0％、83.6％和81.5％,阴性预测值分别为10/11、34.3％和29.4％.结论 双源CT检查能无创显示胰头癌淋巴结转移,出现环状强化、淋巴结强化前后CT值增加＞20 HU、淋巴结短轴直径≥8 mm时,双源CT检查对其的诊断效能较高.
目的 探討雙源CT檢查對胰頭癌淋巴結轉移的診斷價值.方法 迴顧性分析2007年12月至2009年12月第三軍醫大學西南醫院收治的52例經病理檢查結果證實的胰頭癌患者的臨床資料,所有患者行雙源CT平掃和增彊掃描,將CT圖像上的淋巴結與病理標本比較,記錄淋巴結的部位、數目,測量其短軸、長軸直徑併計算各淋巴結的短長軸直徑比,淋巴結的彊化方式以及CT值的變化.分彆以淋巴結短軸直徑≥5、8、10 mm作為淋巴結髮生轉移的診斷標準,統計各種不同標準的敏感度、特異度、暘性預測值、陰性預測值及準確度.計量資料組間均數比較採用f檢驗,計數資料採用x2檢驗.結果 52例胰頭癌患者淋巴結轉移率為67.3％(35/52).切除標本中共檢齣163枚淋巴結,病理檢查診斷其中118枚髮生轉移.第13組與第17組、第12組、第14組、第16組淋巴結轉移率分彆為80.0％ (28/35)、85.7％ (30/35)、97.1％(34/35)、20.0％(7/35).CT檢查診斷環狀彊化的淋巴結轉移率為100.0％(56/56),均勻彊化的淋巴結轉移率為71.0％(76/107),兩者比較,差異有統計學意義(x2=18.198,P＜0.05).轉移淋巴結CT值增加(25.0 ±3.3)HU,未轉移淋巴結CT值增加(14.0±2.0)HU,兩者比較,差異有統計學意義(=22.732,P＜0.05).轉移淋巴結和未轉移淋巴結的平均短軸直徑、長軸直徑、短長軸直徑比分彆比較,差異均有統計學意義(t=3.732,3.354,3.430,P＜0.05).分彆以淋巴結短軸直徑≥5、8、10 mm作為淋巴結髮生轉移的診斷標準,雙源CT檢查的敏感度分彆為99.2％、43.2％和18.6％,特異度分彆為22.2％、77.7％和88.9％,暘性預測值分彆為77.0％、83.6％和81.5％,陰性預測值分彆為10/11、34.3％和29.4％.結論 雙源CT檢查能無創顯示胰頭癌淋巴結轉移,齣現環狀彊化、淋巴結彊化前後CT值增加＞20 HU、淋巴結短軸直徑≥8 mm時,雙源CT檢查對其的診斷效能較高.
목적 탐토쌍원CT검사대이두암림파결전이적진단개치.방법 회고성분석2007년12월지2009년12월제삼군의대학서남의원수치적52례경병리검사결과증실적이두암환자적림상자료,소유환자행쌍원CT평소화증강소묘,장CT도상상적림파결여병리표본비교,기록림파결적부위、수목,측량기단축、장축직경병계산각림파결적단장축직경비,림파결적강화방식이급CT치적변화.분별이림파결단축직경≥5、8、10 mm작위림파결발생전이적진단표준,통계각충불동표준적민감도、특이도、양성예측치、음성예측치급준학도.계량자료조간균수비교채용f검험,계수자료채용x2검험.결과 52례이두암환자림파결전이솔위67.3％(35/52).절제표본중공검출163매림파결,병리검사진단기중118매발생전이.제13조여제17조、제12조、제14조、제16조림파결전이솔분별위80.0％ (28/35)、85.7％ (30/35)、97.1％(34/35)、20.0％(7/35).CT검사진단배상강화적림파결전이솔위100.0％(56/56),균균강화적림파결전이솔위71.0％(76/107),량자비교,차이유통계학의의(x2=18.198,P＜0.05).전이림파결CT치증가(25.0 ±3.3)HU,미전이림파결CT치증가(14.0±2.0)HU,량자비교,차이유통계학의의(=22.732,P＜0.05).전이림파결화미전이림파결적평균단축직경、장축직경、단장축직경비분별비교,차이균유통계학의의(t=3.732,3.354,3.430,P＜0.05).분별이림파결단축직경≥5、8、10 mm작위림파결발생전이적진단표준,쌍원CT검사적민감도분별위99.2％、43.2％화18.6％,특이도분별위22.2％、77.7％화88.9％,양성예측치분별위77.0％、83.6％화81.5％,음성예측치분별위10/11、34.3％화29.4％.결론 쌍원CT검사능무창현시이두암림파결전이,출현배상강화、림파결강화전후CT치증가＞20 HU、림파결단축직경≥8 mm시,쌍원CT검사대기적진단효능교고.
Objective To investigate the diagnostic value of dual-source computed tomography (CT) for the lymphatic metastasis of the pancreatic head cancer.Methods The clinical data of 52 patients with pancreatic head cancer who were admitted to the Southwest Hospital from December 2007 to December 2009 were retrospectively analyzed.All patients received plain and enhanced scan by dual-source CT,and the distributions,number,short and long axis diameters and ratio of short-to long-axis diameter,enhancement modality and enhancement degree of lymph nodes were recorded by comparing the CT images and the pathological results.Different diagnostic thresholds including short-axis diameter greater than or equal to 5 mm,8 mm or 10 mm were used as the criteria for judging lymph node metastasis.The sensitivities,specificities,positive-and negative-predictive values and the accuracies of the 3 criteria were calculated respectively.All data were analyzed using the t test or chi-square test.Results The positive rate of lymph node metastasis of the 52 patients was 67.3％ (35/52).Lymph node metastases were found in 118 out of 163 lymoh nodes.The metastatic rates of No.13 and 17,12,14,16 lymph nodes were 80.0％ (28/35),85.7％ (30/35),97.1％ (34/35),20.0％ (7/35),respectively.The increased CT value of metastatic lymph nodes was (25.0 ± 3.3) HU,which was significantly higher than (14.0 ± 2.0) HU of patients with negative metastatic lymph nodes (t =22.732,P ＜ 0.05).The short-and long-axis diameters and the ratio of short-to long-axis diameter showed significant difference between metastatic and negative lymph nodes (t =3.732,3.354,3.430,P ＜ 0.05).The positive rate of lymphatic metastasis with rim-like enhancement was 100.0％ (56/56),which was significantly higher than 71.0％ (76/107) of lymphatic metastasis with homogeneous enhancement (x2=18.198,P＜0.05).Using the short axis diameters≥5 mm,8 mm and 10 mm as the standards for diagnosing lymph node metastasis,the sensitivities of the dual-source CT were 99.2％,43.2％ and 18.6％,the specificities were 22.2％,77.7％ and 88.9％,the positive predictive values were 77.0％,83.6％ and 81.5％,and the negative predictive values were 10/11,34.3％ and 29.4％,respectively.Conclusions Dual-source CT could detect lymph node metastasis of the cancer of the head of pancreas without causing trauma.When the rim-like enhancement and increased value after enhancement ＞ 20 HU,short axis diameter of the lymph nodes ≥ 8 mm,high sensitivity of dual-source CT for the diagnosis of lymph node metastasis of cancer of the head of pancreas could be achieved.
