CAJ | 학술논문

目的：比较常规 CT 结肠镜（CTC）与双能量 CTC 检测占位性病变的准确性。方法选择临床怀疑有结肠占位性病变患者28例，均采用双能量增强 CT 扫描，并进行结肠镜重建和双能量碘图重建。比较结肠占位性病变的直径、增强后 CT 值和含碘值。以结肠镜及病理结果作为金标准，比较常规 CTC 和双能量 CTC 诊断结肠占位性病变的敏感度、特异度、准确率、阳性预测值和阴性预测值。多组间的计量资料比较采用方差分析，计数资料比较采用卡方检验。结果28例患者中，CTC 检出结肠占位性病变24例，经结肠镜及病理证实假阳性4例，假阴性1例。双能量 CTC 检出结肠占位性病变20例，经结肠镜及病理证实无假阳性患者，假阴性1例。腺瘤样息肉、腺瘤、腺癌和粪块增强后的 CT 值分别为（38．54±6．82）、（49．16±7．31）、（52．61±5．93）和（34．00±1．41）Hu，腺瘤和腺癌的强化值明显高于腺瘤样息肉和粪块，差异有统计学意义（F ＝10．760，P ＝0．001）；息肉与粪块两组间比较，差异无统计学意义（t ＝1．44，P ＝0．188）。常规 CTC 与双能量 CTC 检测占位性病变的敏感度分别为95．6％（95％CI ：77．9％～99．2％）和95．6％（95％CI ：77．9％～99．2％），特异度分别为42．8％（95％CI ：15．4％～93．5％）和100．0％（95％CI ：47．9％～100．0％）。结论与传统的 CTC 相比，双能量 CTC 可区分粪便残渣与肿块，有助于肿瘤良恶性的鉴别，进一步提高 CTC 诊断的准确性。
목적：비교상규 CT 결장경（CTC）여쌍능량 CTC 검측점위성병변적준학성。방법선택림상부의유결장점위성병변환자28례，균채용쌍능량증강 CT 소묘，병진행결장경중건화쌍능량전도중건。비교결장점위성병변적직경、증강후 CT 치화함전치。이결장경급병리결과작위금표준，비교상규 CTC 화쌍능량 CTC 진단결장점위성병변적민감도、특이도、준학솔、양성예측치화음성예측치。다조간적계량자료비교채용방차분석，계수자료비교채용잡방검험。결과28례환자중，CTC 검출결장점위성병변24례，경결장경급병리증실가양성4례，가음성1례。쌍능량 CTC 검출결장점위성병변20례，경결장경급병리증실무가양성환자，가음성1례。선류양식육、선류、선암화분괴증강후적 CT 치분별위（38．54±6．82）、（49．16±7．31）、（52．61±5．93）화（34．00±1．41）Hu，선류화선암적강화치명현고우선류양식육화분괴，차이유통계학의의（F ＝10．760，P ＝0．001）；식육여분괴량조간비교，차이무통계학의의（t ＝1．44，P ＝0．188）。상규 CTC 여쌍능량 CTC 검측점위성병변적민감도분별위95．6％（95％CI ：77．9％～99．2％）화95．6％（95％CI ：77．9％～99．2％），특이도분별위42．8％（95％CI ：15．4％～93．5％）화100．0％（95％CI ：47．9％～100．0％）。결론여전통적 CTC 상비，쌍능량 CTC 가구분분편잔사여종괴，유조우종류량악성적감별，진일보제고 CTC 진단적준학성。
[Abstract ] Objective To compare the accuracy between regular computed tomography colonography (CTC)and dual-energy CTC in lesion detection.Methods Twenty-eight patients with clinical suspicious space occupying lesions of the colon were selected.All patients were underwent dual-energy mode contrast-enhanced CT scan and the data were reconstructed with colonography and dual-energy iodine maps methods.The diameter,enhanced computed tomography (CT)value and iodine value were measured.The results of colonoscopy and pathology were taken as gold standard.The sensitivity, specificity,accuracy,positive predictive value and negative predictive value of regular CTC and dual-energy CTC were compared.Variance analysis was performed for measurement data comparison among groups and chi-square test was used for count data analysis.Results Among 28 patients,colorectal lesions were detected in 24 cases by regular CTC,of which four cases were false-positive and one case was false-negative confirmed by colonoscopy and pathology.Colorectal lesions were detected in 20 cases by dual-energy CTC,of which no false-positive and one case was false negative confirmed by colonoscopy and pathology.The contrast enhanced CT value of polyps,adenoma,adenocarcinoma and stool was (38.54± 6.82),(49.16±7.31 ),(52.61 ±5 .93 )and (34.00±1 .41 )Hu,respectively.The enhanced value of adenoma and adenocarcinoma was significantly higher than that of polyps and stool,the differences were statistically significant among groups (F = 10.760,P = 0.001 ).There was no significant difference between polyps and stool (t=1 .44,P =0.188).The sensitivity of regular CTC and dual-energy CTC in lesion detection was 95 .6% (95 %cofidence interval(CI ):77.9%-99.2%)and 95 .6% (95 %CI :77.9%-99.2%),respectively.The specificity was 42.8% (95 %CI :15 .4%-93.5 %)and 100.0% (95 %CI :47.9%-100.0%).Conclusion Compared with traditional CTC,dual-energy CTC would distinguish lesions from stool,help differentiate between benign and malignant tumors and further increase the accuracy of CTC diagnosis.