CAJ | 학술논문

目的探讨肠系膜CTA对小肠肿瘤的诊断价值.方法回顾性分析经手术病理证实并行肠系膜血管CTA检查的51例小肠肿瘤患者资料.观察CTA图像表现,包括肿瘤供血动脉、引流静脉、系膜侧直小血管及肿瘤血管情况.并由2名放射诊断医师分别盲法对照手术病理结果,分别采用小肠肿瘤供血动脉定位法和Coles分组定位法对肿瘤进行定位诊断.采用McNemar配对x2检验评价医师分别采用2种定位诊断方法诊断准确性的差异,采用一致性检验评价2名医师诊断结果的一致性.结果小肠肿瘤CTA表现为供血动脉增粗12例,引流静脉早显9例,小肠系膜侧直小血管增粗22例,肿瘤内及周围肿瘤血管形成11例.2名医师采用Cole分组法和供血动脉法定位诊断的准确率分别为84.31％(43/51)和98.03％(50/51).2名医师采用Coles分组法诊断具有中度一致性(Kappa=0.49,P＜0.01),采用供血动脉法诊断具有高度一致性(Kappa=1.00,P＜0.01).2名医师分别采用Coles分组法和供血动脉法定位诊断的准确性差异均无统计学意义(P值分别为0.062和0.125).结论肠系膜CTA可显示小肠肿瘤的供血动脉和引流静脉,具有定位、定性诊断价值.
목적 탐토장계막CTA대소장종류적진단개치.방법 회고성분석경수술병리증실병행장계막혈관CTA검사적51례소장종류환자자료.관찰CTA도상표현,포괄종류공혈동맥、인류정맥、계막측직소혈관급종류혈관정황.병유2명방사진단의사분별맹법대조수술병리결과,분별채용소장종류공혈동맥정위법화Coles분조정위법대종류진행정위진단.채용McNemar배대x2검험평개의사분별채용2충정위진단방법진단준학성적차이,채용일치성검험평개2명의사진단결과적일치성.결과 소장종류CTA표현위공혈동맥증조12례,인류정맥조현9례,소장계막측직소혈관증조22례,종류내급주위종류혈관형성11례.2명의사채용Cole분조법화공혈동맥법정위진단적준학솔분별위84.31％(43/51)화98.03％(50/51).2명의사채용Coles분조법진단구유중도일치성(Kappa=0.49,P＜0.01),채용공혈동맥법진단구유고도일치성(Kappa=1.00,P＜0.01).2명의사분별채용Coles분조법화공혈동맥법정위진단적준학성차이균무통계학의의(P치분별위0.062화0.125).결론 장계막CTA가현시소장종류적공혈동맥화인류정맥,구유정위、정성진단개치.
Objective To investigate the value of mesenteric vascular CTA in the diagnosis of small intestinal neoplasms.Methods A retrospective analysis of mesenteric CTA from January 2008 to April 2013 was conducted in 51 patients with pathologically proven small intestinal neoplasms.Features of intestinal neoplasms CTA signs including neoplasm feeding artery,draining vein,mesangial side vasa recta and the formed neoplasm vessels,were observed.Two radiologists individually used two methods,namely intestinal tumor feeding artery positioning method and Cole fractionation method,for diagnosis and localization diagnosis of tumor,and also for comparing the results with those of surgical pathology.McNemar Chi-square test was adopted to evaluate the diagnosis differences between the two physicians and between the two methods by the same physician.Kappa value was used to assess the consistency of the results.Results Features of intestinal tumors CTA signs:12 cases of enlarged neoplasm feeding artery,9 cases of early displayed draining vein,22 cases of enlarged mesangial side vasa recta,and 11 cases of vessels formed inside and around the neoplasm,single lesion for all and the largest lesion diameter≥ 5 cm for 37 cases.The accuracy of Cole fractionation method positioning and the feeding artery positioning were 84.31％(43/51) and 98.03％(50/51) respectively.Moderate consistency(Kappa=0.49,P＜0.01) was seen with Cole fractionation method by the two physicians and high consistency(Kappa=1.00,P＜0.01) with feeding artery positioning method.McNemar Chi-square test showed no significant difference between the two methods by the same physician and the consistency of the results from the two methods was passable(P were 0.062 and 0.125).Conclusion Mesenteric CTA can display the intestinal tumor feeding arteries and draining veins,and is helpful in identification of the relationship between the tumor and its surrounding blood vessels,which can improve the accuracy of pre-operative localization and qualitative diagnosis for small intestinal tumor.