胃肠道间质瘤的CT和MRI特征及其与病理危险度的关系

目的探讨胃肠道间质瘤(GIST)的计算机断层扫描(CT)和核磁共振成像(MRI)特征,并分析其与病理危险度的关系。方法收集52例GIST患者的临床资料,所有患者均接受了腹部CT和MRI检查,观察病变的形态学特征。根据美国国立卫生研究院原发GIST危险度分级方案,将GIST患者分为高危组(n=16)、中危组(n=16)、低危组(n=15)和极低危组(n=5),分析不同组别GIST患者的CT和MRI特征。结果高危组、中危组、低危组、极低危组GIST患者的肿瘤直径、形状、密度分布情况、瘤内继发改变、CT强化程度及强化方式比较,差异均有统计学意义(P<0.01)。极低危组和低危组GIST的肿瘤直径较小,形状规则,密度较均匀,内部无囊性变、溃疡或出血;高危组GIST患者的肿瘤直径较大,形状较不规则,密度不均匀,多数可见囊性变,少数可见溃疡和出血。极低危组和低危组GIST患者的平均表观弥散系数(ADC)值为(1.81±0.21)×10^-3,中危组GIST患者的平均ADC值为(1.69±0.18)×10^-3,高危组GIST患者的平均ADC值为(1.21±0.21)×10^-3,差异有统计学意义(P<0.01)。结论 GIST的CT和MRI表现具有一定的特征,通过对肿瘤直径、形状、密度、内部囊变情况、ADC值进行分析,可以对肿瘤的危险度做出一定的评估。     

Ki-67在CD117阳性的中、高危险度胃肠道间质瘤中的表达及其意义

 目的　探讨Ki-67在CD117阳性的中、高危险度胃肠道间质瘤（GIST）中的表达及其临床意义。方法　检测Ki-67在CD117阳性的中危险度（GIST）18例、高危险度GIST 25例中的表达,与随访结果对照,并与极低危险度和低危险度组33例比较,分析Ki-67指数（LI）与危险度的关系。结果　中、高危险度组随访40例,其中26例健在,高危组7例、中危组5例死于GIST,另2例死于其他原因。Ki-67 LI> 5 %在危险度中、高组与极低和低组间表达差异有统计学意义（P＜0.01）,Ki-67 LI还与核分裂象计数（MI）（＞5／50 HPF）、肿瘤大小（＞5 cm）相关（P＜0.05）,与部位无关（P＞0.05）。结论　Ki-67 LI＞5 %与肿瘤大小＞5 cm、MI＞5／50 HPF一起可作为CD117阳性的GIST中、高危险度的有用评价指标。     

胃肠间质瘤复发危险度的临床分析

目的:探讨不同临床病理因素对胃肠间质瘤(gastrointestinal stromal tumor,GIST)预后的影响,以期为GIST诊断和治疗以及预后判断提供依据。方法:回顾性分析2001年1月—2006年12月接受手术治疗的128例GIST患者的临床病理资料并进行随访,分析肿瘤原发部位、肿瘤大小、组织学类型、核分裂相、远处转移、甲磺酸伊马替尼等因素和GIST危险度与生存率之间的关系。结果:本组患者CD117表达阳性率为94.5%(121/128),CD34表达阳性率为72.7%(93/128)。按照Miettinen危险度分级标准,相同危险度的胃间质瘤与非胃间质瘤的生存率差异无统计学意义;而组织学类型与危险度分级相关(P=0.0282)。远处转移与GIST患者的生存率密切相关(P<0.0001)。甲磺酸伊马替尼治疗GIST可以明显提高中-高危险度GIST患者的生存率。结论:Miettinen危险度分级标准作为GIST的预后判定标准更为合理。组织学类型和远处转移可以作为评估GIST的重要因素,应在分级标准中予以体现。对中-高度危险的GIST患者,应建议口服甲磺酸伊马替尼治疗。     

肠源性胃肠道间质瘤71例临床分析

目的 探讨分析肠道来源胃肠道间质瘤(gastrointestinal stromal tumor,GIST)患者的临床和病理特征及影响预后的因素.方法 回顾性分析经手术治疗的71例肠源性GIST患者的临床、病理及部分随访资料,对其预后进行单因素分析.结果 71例GIST患者中,病灶原发部位小肠51例,结直肠15例,肠系膜5例.临床表现以消化道出血为主(45.1％,32例),其次为腹部不适及腹部包块(22.5％,16例;16.9％,12例),复发风险极低危l例,低危16例,高危54例.单因素分析显示,肿瘤最大径、核分裂相和复发危险度是影响预后的因素(均P＜0.05).复发风险高危组中,术后服用靶向药物患者的预后好于未服用药物的患者(P＜0.05).结论 肿瘤完整切除联合靶向治疗是肠源性GIST的最佳治疗模式,肿瘤最大直径、核分裂相及复发危险度是影响患者预后的危险因素.     

胃肠道间质瘤免疫表型的表达及临床意义

目的:观察胃肠道间质瘤（GIST）免疫表型的表达,分析其在诊断上的临床意义,探讨其与危险度分级的关系。方法:吉林大学第一医院病理科2010 年 12 月至 2012 年 8月检测的GIST术后标本65 例,采用免疫组化SP法检测CD117、CD34、DOG1、SMA、S-100、Ki-67和Desmin的表达,应用SPSS 17.0对数据进行分析,探讨相关免疫表型与临床病理相关因素的关系。结果:65例GIST中DOG1、CD117、CD34 的阳性率分别为100.0%、96.9%、89.2%。CD34在胃GIST的阳性表达高于小肠GIST(P＜0.05),SMA在小肠GIST的阳性表达高于胃GIST(P＜0.05),Ki-67的表达与肿瘤大小、核分裂相、危险度分级相关。结论:CD117联合CD34、DOG1检测可以提高GIST的诊断率;SMA在小肠GIST中表达率明显高于胃GIST的表达,CD34在胃GIST中表达率高于小肠GIST的表达;Ki-67可以作为一个判定GIST预后的指标。     

原发性胃肠间质肿瘤121例临床分析

目的:探讨胃肠间质肿瘤(gastrointestinal stromal tumor,GIST)的临床特征、治疗以及相关的预后因素.方法:对1999年7月-2007年6月121例原发性GIST患者的临床和病理特征、治疗以及预后情况进行了回顾性分析.结果:原发性GIST患者的男女之比为1.57:1,年龄26～83岁,中位年龄61岁.常见肿瘤部位以胃和小肠多见.CD117阳性114例,CD34阳性94例.121例患者均接受了外科治疗,其中完全切除84例,31例行淋巴结清扫或活检术,获检274枚淋巴结中只有2枚被检出有转移.68例患者于术后接受了3～38个月伊马替尼的治疗.121例患者中有106例接受了7～85个月的随访,1、3、5年累计无进展生存率分别为88.8%、55.6%和35.9%,总生存率分别为97.8%、71.8%和57.0%.单因素生存分析显示,生存率与肿瘤部位、肿瘤大小、核分裂相数目、危险度分级、手术方式以及是否接受伊马替尼治疗有关.分层分析结果显示,完全切除术后危险度分级和伊马替尼治疗是影响术后无复发生存时间的因素.多因素回归分析结果显示,肿瘤大小、核分裂相数、危险度分级、完全切除以及伊马替尼治疗是影响生存预后的独立危险因素.结论:肿瘤大小和核分裂相数是GIST的2个重要的预后因素.完全切除与GIST预后独立相关,但并不提倡常规进行系统淋巴结清扫;伊马替尼可提高GIST的3年生存率,完全切除术后给予伊马替尼治疗可延缓复发或转移.     

胃间质瘤与非胃间质瘤的超声表现及病理危险度分级的对比研究

目的:比较胃间质瘤与非胃间质瘤的超声图像表现及病理危险度分级间的差异,评价超声检查预测胃间质瘤和非胃间质瘤危险度的临床价值。方法:回顾性分析经手术后病理证实为胃肠道间质瘤（GIST）的55例患者的超声图像表现,按肿瘤的生长部位分为胃间质瘤组和非胃间质瘤组,对比分析两组间超声图像表现及病理危险度分级的差异。结果:非胃间质瘤组的恶性危险度更高,在瘤体最大径≤5 cm、呈类圆形、内部不伴无回声、血流稀少方面,两组间危险度相比较均具有统计学差异(P＜0.05)。同时,瘤体最大径>5 cm、形态不规则、内伴无回声、血流丰富和伴有转移的GIST恶性危险度更高,具有统计学差异(P＜0.05)。结论:胃间质瘤与非胃间质瘤的恶性程度存在一定差异,非胃来源的GIST恶性程度高于胃来源的间质瘤,超声图像特征有助于评估肿瘤的危险度,为临床治疗和判断预后提供指导信息。     

胃肠道间质瘤的免疫组化观察与临床病理意义的研究

目的:探讨胃肠道间质瘤(GIST)的临床病理特点以及CD117、CD34、Desmin、DOG-1、S-100、SMA的表达情况,并分析两者之间的关系。方法:用免疫组化SP法检测62例胃肠道间质瘤组织中CD117、CD34、DOG-1、S-100、SMA的表达情况,分析其与临床病理因素(性别、年龄、生长部位、肿瘤大小、核分裂相、组织学类型)的相关性。结果:62例GIST中极低度危险度13例,低度危险度17例,中度危险度13例,高度危险度19例。62例GIST中CD117阳性(93.55%,58/62),CD34阳性(82.26%,51/62),DOG-1阳性(90.32%,56/62),Desmin阳性(3.23%,2/62),SMA阳性(41.93%,26/62),S-100阳性(19.35%,12/62)。CD34的表达与肿瘤大小以及危险度有关。与DOG-1+/CD117+相比,另外两组(DOG-1+/CD34+,CD117+/CD34+)的共同阳性表达率明显降低。在GIST中,与DOG-1相比,CD117在GISTs的阳性率表达中,没有显著的统计学差异,而CD34则存在统计学差异。结论:DOG-1作为GIST的标志物,在诊断GIST方面,与CD117同样具有较好的特异性和敏感性。同时,CD117、CD34及DOG-1这三个指标对于GISTs的正确诊断以及之后的病人的个体化治疗有着指导意义。     

黏着斑激酶在胃肠道间质瘤组织中的表达及临床意义

目的:探讨黏着斑激酶(focal adhesion kinase,FAK)蛋白在胃肠道间质瘤（gastrointestinal stromal tumor,GIST）组织中的表达及临床意义。方法:采用免疫组化方法检测90例GIST组织中FAK的表达,并分析其与GIST患者临床病理特征的关系。结果:FAK在GIST组织中的阳性表达率为65.6%。FAK蛋白表达水平与患者性别、年龄、肿瘤原发部位、核分裂数无相关性,而与肿瘤直径、肿瘤危险度分级有密切关系。结论:FAK的过表达可能参与GIST的发生、发展,在肿瘤分子分型、预后判断及靶向治疗方面具有潜在的应用价值。     

CSPG4在胃肠间质瘤中的表达及其与临床参数及肿瘤免疫细胞的关系

目的:通过检测硫酸软骨素蛋白聚糖4(chondroitin sulfate proteoglycan 4，CSPG4)在胃肠间质瘤（gastrointestinal stromal tumor，GIST）中的表达情况,探讨其与临床病理参数和免疫细胞的相关性。方法:运用免疫组化EnVision二步法检测162例GIST中CSPG4蛋白的表达情况，分析其与年龄、性别、发生部位及NIH危险度分级的相关性，并探讨GIST中CSPG4蛋白的表达与肿瘤浸润淋巴细胞（tumor-infiltrating lymphocytes，TILs）CD4+、CD8+、CD20+、CD56+及CD68+细胞计数的关系。结果:CSPG4蛋白在GIST中的表达与发生部位及NIH危险度分级相关(P＜0.05)，与年龄及性别差异无统计学意义(P＞0.05)。CSPG4蛋白在GIST中的表达与CD8+、CD56+及CD68+细胞计数相关(P＜0.05)，而与CD4+及CD20+细胞计数差异无统计学意义(P＞0.05)。结论:CSPG4蛋白表达水平在一定程度上可预测GIST的生物学行为，CSPG4蛋白可能通过调节肿瘤免疫微环境参与GIST的发生和发展。     

胃肠道间质瘤的超声表现与病理危险度分级的对照研究

目的:总结胃肠道间质瘤的超声表现,评价超声检查评估胃肠道间质瘤病变危险度的临床应用价值。方法:搜集经术后病理证实为胃肠道间质瘤的33例患者进行回顾性分析,总结其术前超声图像表现,对病变的各种超声特征与病变危险度分级之间进行对照研究。结果:33例胃肠道间质瘤中,高度危险性7例（21.2%）,中度危险性9例（27.3%）,低度危险性15例（45.5%）,极低度危险性2例（6.1%）。在超声图像上,胃肠道间质瘤的危险度在肿瘤的最大径线、生长方式、边界、内部伴无回声区和瘤体内血流信号方面的差异具有统计学意义（P<0.05）,而在肿瘤内部回声程度方面的差异无统计学意义（P>0.05）。结论:胃肠道间质瘤的超声图像表现对病变危险度的评估具有重要的临床价值,为该病治疗方案的选择和随访提供重要参考信息。     

超声检查对小肠间质瘤的诊断价值

目的探讨超声检查对小肠间质瘤的临床诊断价值。方法对福建省肿瘤医院2008年4月至2015年5月收治且经手术及病理证实的39例小肠间质瘤患者的超声资料进行回顾性分析。结果按病理危险分级标准将39例患者分为极低危组(1例)、低危组(11例)、中等危组(1例)、高危组(26例)。超声诊断符合率为64.1%(25/39),漏诊2例(5.1%)。低危组病灶超声表现均呈边界清楚的低回声团块,多呈类圆形,内部回声均匀,团块内部多见Ⅰ级血流信号(63.6%,7/11);高危组病灶呈囊实性和低回声,团块多数边界清楚,但内部回声不均,46.2%呈分叶状,团块内部多见Ⅱ~Ⅲ级血流信号(61.5%,16/26)。结论超声作为临床应用最广的检查项目之一,对小肠间质瘤的术前筛查具有重要价值,结合临床表现有助于提高其诊断率。     

Chemosensitivity and stratification by a five monoclonal antibody immunohistochemistry test in the NSABP B14 and B20 trials

PURPOSE: To test the association between risk stratification and outcome in a prospectively designed, blinded retrospective study using tissue arrays of available paraffin blocks from the estrogen receptor-expressing, node-negative samples from the National Surgical Adjuvant Breast and Bowel Project B14 and B20 tamoxifen and chemotherapy trials. EXPERIMENTAL DESIGN: Tissue arrays were stained by immunohistochemistry targeting p53, NDRG1, SLC7A5, CEACAM5, and HTF9C. Risk stratification was done using predefined scoring rules, algorithm for combining scores, and cutoff points for low-risk, moderate-risk, and high-risk patient strata. RESULTS: In a univariate Cox model, this test was significantly associated with recurrence-free interval [HR, 1.3 (95% confidence interval, 1.1-1.6); P = 0.006]. In a multivariate model it contributed information independent of age, tumor size, and menopausal status (P = 0.007). The Kaplan-Meier estimates of the proportion of recurrence-free after 10 years were 73%, 86%, and 85% for the high-risk, moderate-risk, and low-risk groups (P = 0.001). The Kaplan-Meier estimates of the breast-cancer-specific-death rate were 23%, 10%, and 9% (P < 0.0001). Exploratory analysis in patients >/=60 years old showed Kaplan-Meier estimates of the proportion of recurrence-free of 78%, 89%, and 92%. Both high-risk and low-risk groups showed significant improvement on treatment with cytotoxic chemotherapy. CONCLUSIONS: Immunohistochemistry using five monoclonal antibodies assigns breast cancer patients to a risk index that was significantly associated with clinical outcome among the estrogen receptor-expressing, node-negative tamoxifen-treated patients. It seems that the test may be able to identify patients who have greater absolute benefit from adjuvant chemotherapy compared with unstratified patient populations. Exploratory analysis suggests that this test will be most useful in clinical decision making for postmenopausal patients.     

Preventive health behaviors and familial breast cancer.

AIM: To examine medical and lifestyle preventive behaviors among women with varying levels of familial breast cancer risk. METHODS: Using cross-sectional data from the Minnesota Breast Cancer Family Study, a historical cohort of 426 families, we compared medical (mammography adherence, antiestrogen use, and prophylactic surgery) and lifestyle (physical activity, smoking, alcohol, and diet) behaviors across three groups of cancer-free women ages 18 to 95 defined by their family history of breast cancer. Family history was classified as high-risk, moderate-risk, or average to low-risk depending on the number and degree of relationship of family members with breast cancer. RESULTS: After adjusting for age and education, high-risk women were twice as likely to have ever used an antiestrogenic agent (9.0% versus 4.6% among moderate-risk and 4.1% among average to low-risk; P = 0.002). Among women ages <40, the high-risk group were more likely to have ever had a mammogram (82% versus 47% among moderate-risk and 35% among average to low-risk; P < 0.001). Average to low-risk women were the least likely to be current smokers and high-risk women may consume slightly fewer fruits and vegetables compared with the other groups, but there were no other differences in lifestyle behaviors, including physical activity and alcohol use. CONCLUSIONS: Women with strong family histories of breast cancer are more likely to undertake medical but not lifestyle preventive behaviors.     

超声在小肠间质瘤恶性风险评估中的价值

目的：探讨超声评估小肠间质瘤恶性风险的价值。方法回顾性分析经手术病理和免疫组化证实的55例小肠间质瘤患者的声像图表现,依据胃肠道间质瘤（gastrointestinal stromal tumor,GIST）病理危险度分级将其分为低危组、中危组、高危组;声像图分析包括肿瘤的大小、形态、边界、内部回声,并对各组的上述征象进行方差分析或Fisher精确检验。结果55例小肠间质瘤中,低危组患者有8例,中危组患者有3例,高危组患者有44例。病灶最大径为3.5～28.0 cm;低危组病灶平均大小为4.3 cm,中危组为7.2 cm,高危组为11.2 cm。与低危组患者中出现回声不均、分叶、囊变的比例（25.0%、37.5%、25.0%）相比,中危组和高危组的比例高,分别为100.0%、100.0%、66.7%和88.6%、86.4%、81.8%;肿瘤大小、回声均质性、分叶、囊变在不同组间的差异有显著的统计学意义（均P＜0.05）。不同危险度分组中,肿瘤内有气体回声的比例在中危组（1/3,33.3%）和高危组（8/44,18.2%）中均高于低危组（0/8,0）;血流丰富的比例在高危组（17/44,38.6%）中的比例高于低危组（0/8,0）和中危组（1/8,12.5%）,但无统计学意义（P＞0.05）。结论超声对评估小肠间质瘤恶性风险有一定价值。     

Rationalization and regionalization of treatment for ductal carcinoma in situ of the breast

PURPOSE: In ductal carcinoma in situ (DCIS) of the breast, conservative surgery plus radiotherapy (CS+RT) decreases risk of recurrence compared with CS alone. Although nearly one third of patients are reported as treated with CS alone, it is unclear whether this potentially "undertreated" group represents high- or low-risk patients. We evaluated national patterns of DCIS treatment from 1996 to 2001 by patient risk profile. METHODS AND MATERIALS: In a retrospective cohort of DCIS patients from the Surveillance, Epidemiology, and End Results data, patients were risk stratified on the basis of age at diagnosis, tumor grade, tumor size, and comedo histology. Treatment included CS alone, CS+RT, or mastectomy. Patients were followed for the development of ipsilateral invasive or in situ event. RESULTS: Of 14,202 patients, 19% were low-risk, 46% moderate-risk, and 35% high-risk. A total of 28% received CS alone, 40% CS+RT, and 31% mastectomy. Overall, only 17% of high-risk patients but 44% of low-risk patients received CS alone (p < 0.001). In multivariable analysis, older age, smaller tumor size, and treatment in San Francisco/Los Angeles predicted treatment with CS alone (p < 0.01). Yet despite the tendency to receive CS alone, patients in San Francisco/Los Angeles did not experience an increased risk of ipsilateral event (hazard ratio = 0.79; 95% confidence interval, 0.55-1.12). CONCLUSION: Patient risk profiles rationally affect treatment choice in DCIS patients, and the vast majority of high-risk patients do not receive CS alone. Additional follow up is needed to determine whether geographic variation in care influences long-term outcomes.     

预后营养指数及EORTC-GUCG评分对膀胱癌患者复发预测价值的探讨

目的:探讨预后营养指数（prognostic nutritional index,PNI）及EORTC-GUCG评分对膀胱癌患者复发的预测价值。方法:收集96例非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC）患者为研究对象。根据术前EORTC-GUCG评分，将患者分为低危组、中危组及高危组，比较不同风险患者的无复发生存期（recurrence-free survival,RFS）。采用ROC曲线确定PNI预测复发风险的截断值，比较不同PNI患者的RFS。结果:肿瘤数量、肿瘤大小、肿瘤分级、T分期是影响膀胱癌患者EORTC-GUCG评分的主要危险因素（P＜0.05），而年龄、肿瘤分级是影响患者PNI的主要危险因素（P＜0.05）。EORTC-GUCG低危组、中危组、高危组分别出现2例、23例、13例复发。Kaplan-Meier生存曲线显示，高危组RFS最差,中危组次之，低危组最好，差异均具有统计学意义（P＜0.05）。ROC曲线显示，PNI对RFS评价的曲线下面积为0.757，最佳截断值为53.3。PNI＜53.3组与PNI≥53.3组的复发率分别为23.1%、59.1%，生存曲线显示，PNI≥53.3组患者RFS显著差于PNI＜53.3组（P=0.001）。低危组、中危组、高危组中，PNI＜53.3的患者分别为13例、34例、5例，PNI≥53.3的分别有6例、22例、16例。生存曲线显示，在低危组内，PNI＜53.3组与PNI≥53.3组患者之间的生存率无明显差异（P=0.106），在中危组及高危组内，PNI≥53.3组患者的RFS明显更差（P=0.000，P=0.031）。结论:53.3可作为PNI的最佳截断值，用于评价NMIBC患者复发风险。将PNI与EORTC-GUCG评分相结合，对中危及高危患者的复发风险有较高的预测价值。     

Risk stratification for acute pulmonary embolism

This article discusses state-of-the-art techniques for predicting risk of death after acute pulmonary embolism (PE), with special attention to how underlying malignancy adversely affects survival after an episode. Current methods of risk stratification generally categorize patients with PE as low-, moderate-, and high-risk for in-hospital adverse outcomes of respiratory failure, circulatory shock, and death. Published risk stratification studies find that patients with PE and an underlying malignancy have a worse prognosis, but no validated risk stratification criteria have been published specifically for these patients. Standard treatment is full-dose heparin followed by oral anticoagulation. The term escalated treatment refers to the use of systemic or intrapulmonary fibrinolytic agents, catheter-based treatment, or surgical embolectomy. Most patients with low-risk PE (normal vital signs and normal serum troponin, brain natriuretic peptide, and normal echocardiography) are treated successfully with standard anticoagulation, and many can be treated as outpatients. In contrast, patients with high-risk PE (systolic blood pressure < 90 mm Hg and no contraindications) often benefit from escalated treatment. Treatment decisions for patients with moderate-risk PE (normotension with evidence of right ventricular damage or dysfunction) are most controversial. Most patients in this category of risk recover with standard therapy, but some benefit from escalated treatment. Patients with cancer with an incidentally discovered PE should be risk stratified the same as those who have clinically suspected PE.     

MSCT征象联合纹理分析在预测胸腺上皮性肿瘤WHO简化病理分型中的价值

背景与目的：胸腺上皮性肿瘤（thymic epithelial tumor，TET）是前上纵隔最常见的原发肿瘤，其组织学分型是判断预后的独立危险因素。探讨和比较术前多层螺旋计算机断层扫描（multi-slice spiral computed tomography，MSCT）征象及基于CT图像的纹理分析在预测TET世界卫生组织（World Health Organization，WHO）简化病理分型中的价值。方法：回顾并分析2011年1月—2018年6月复旦大学附属肿瘤医院手术后经病理学检查证实为TET、且经免疫组织化学确定组织分型的120例患者的增强CT图像及临床资料，并根据WHO简化病理分型分为低危组（A1、AB、B1型胸腺瘤）及高危组（B2、B3型胸腺瘤及胸腺癌）。评估及记录每例TET患者的CT征象。选用纵隔窗CT图像进行病灶分割及纹理特征的提取。采用R软件套索（least absolute shrinkage and selection operator，Lasso）模型进行特征筛选及模型建立。采用受试者工作特征 （receiver operating characteristic，ROC）曲线和曲线下面积（area under curve，AUC）评价模型的预测效能。不同预测模型之间诊断效能的比较采用DeLong检验。结果：120例TET患者中低危组61例，高危组59例，分别记录及提取了每例患者CT图像的11种CT征象和14种纹理特征。分别建立了以MSCT征象、纹理参数以及两者联合为基础的CT预测模型、纹理预测模型以及联合预测模型，3个模型在预测低危组及高危组TET的AUC分别为0.78、0.80、0.88，灵敏度分别为86.4%、88.1%和93.2%，特异度分别为60.7%、65.6%和67.2%，准确率分别为70.8%、74.2%和80.0%。DeLong检验结果显示，联合预测模型在预测TET恶性程度中的效能及准确率最高（P<0.05）。结论：MSCT检查是TET首选的影像学检查方法，纹理特征比肉眼评估得到的CT征象更能反映TET的微观异质性程度，CT征象与纹理特征相结合在预测TET恶性程度中更有优势，可为临床制订治疗方案及评估预后提供更全面及准确的依据。