CAJ | 학술논문

目的探讨术前64层螺旋CT血管造影(64-SCTA)在胰腺恶性肿瘤血管受侵程度与可切除性评估中的临床应用价值.方法回顾性分析西安交通大学医学院第一附属医院2009年10月至2012年3月34例胰腺恶性肿瘤的术前64-SCTA资料,将胰腺恶性肿瘤对邻近血管的侵犯程度分5级,分别对动脉、静脉的受侵程度与病变的可切除性进行评估,并与详细的手术记录进行了对照.结果病变邻近动脉受侵程度1级8例,2级6例,3级8例,4级10例,5级2例,评价经典切除术可切除的敏感性为92.9％,特异性为95.0％,准确性为94.1％,阳性预测值为92.9％,阴性预测值为95.0％,Kappa值0.879(P ＜0.01),ROC曲线下面积为0.943(P ＜0.01).静脉受侵程度1级0例,2级6例,3级6例,4级13例,5级9例,评价经典切除术可切除的敏感性为78.6％,特异性为95.0％,准确性为88.2％,阳性预测值为91.7％,阴性预测值为86.4％,Kappa值0.752(P ＜0.01),ROC曲线下面积为0.927(P＜0.01).结论 64-SCTA是术前评价胰腺恶性肿瘤邻近血管受侵程度、可切除性的方便、有效方法,准确性高,有很高的临床诊断和应用价值.
목적 탐토술전64층라선CT혈관조영(64-SCTA)재이선악성종류혈관수침정도여가절제성평고중적림상응용개치.방법 회고성분석서안교통대학의학원제일부속의원2009년10월지2012년3월34례이선악성종류적술전64-SCTA자료,장이선악성종류대린근혈관적침범정도분5급,분별대동맥、정맥적수침정도여병변적가절제성진행평고,병여상세적수술기록진행료대조.결과 병변린근동맥수침정도1급8례,2급6례,3급8례,4급10례,5급2례,평개경전절제술가절제적민감성위92.9％,특이성위95.0％,준학성위94.1％,양성예측치위92.9％,음성예측치위95.0％,Kappa치0.879(P ＜0.01),ROC곡선하면적위0.943(P ＜0.01).정맥수침정도1급0례,2급6례,3급6례,4급13례,5급9례,평개경전절제술가절제적민감성위78.6％,특이성위95.0％,준학성위88.2％,양성예측치위91.7％,음성예측치위86.4％,Kappa치0.752(P ＜0.01),ROC곡선하면적위0.927(P＜0.01).결론 64-SCTA시술전평개이선악성종류린근혈관수침정도、가절제성적방편、유효방법,준학성고,유흔고적림상진단화응용개치.
Objective To assess for preoperative evaluation of 64-slice spiral computed tomographical angiography (64-SCTA) to predict vascular involvement and general resectability of pancreatic malignant tumors.Methods The material of 64-SCTA in 34 cases were retrospectively analyzed.Preoperative imaging findings were correlated with intraoperative and histopathologic results.Results For the arterial tumor invasion based on 64-SCTA findings,1 grade was in 8 cases; 2 grade,6 cases; 3 grade,8 cases; 4 grade,10 cases; 5 grade,2 cases.Regarding respectability,the sensitivity,specificity,accuracy,positive predictive value (PPV),negative predictive value (NPV) were 92.9％,95.0％,94.1％,92.9％,95.0％.Kappa value was 0.879 (P ＜ 0.01).Receiver operator characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.943 (P ＜ 0.01).For the venous tumor infiltration,1grade was in 0 case; 2 grade,6cases; 3 grade,6 cases; 4 grade,13 cases; 5 grade,9 cases.Regarding respectability,these values for those tumors with vein invasion were 78.6％,95.0％,88.2％,91.7％,86.4％.Kappa value was 0.752 (P ＜ 0.01).ROC analysis showed an AUC of 0.927 (P ＜ 0.01).Conclusion 64-SCTA can provide reliable information for vascular involvement and general resectability of pancreatic malignant tumors.64-SCTA has high value in clinical application.