头颈部CT血管成像对颈动脉体瘤术中出血量评估的临床应用价值

目的 探讨头颈部CT血管成像(CTA)对颈动脉体瘤术中出血量评估的应用价值。方法 回顾性分析36例经诊断颈动脉体瘤并行手术治疗的患者的头颈部CTA影像资料,对比分析术中出血量<500 ml组与出血量≥500 ml组的患者年龄、性别、病程、Shamblin分型、病灶轴位最大径、上下最大径、平扫及增强动脉期CT值的差别。对有统计学意义的头颈CTA单一参数进行Logistics回归分析,得到回归方程以及包含多项单参数预测概率的联合参数。对头颈CTA单一参数及联合参数进行受试者工作特征曲线分析,确定诊断阈值。结果 颈动脉体瘤术中出血量<500 ml组与出血量≥500 ml组患者年龄(P=0.019)、肿瘤的上下最大径(P=0.004)、轴位最大径(P=0.003)、Shamblin分型(P=0.012)、供血动脉数量(P<0.001)差异均有统计学意义。绘制受试者工作特征曲线,供血动脉数量、轴位最大径、上下最大径、Shamblin分型以及联合参数的受试者工作特征曲线下面积分别为0.865、0.781、0.806、0.766和0.927。联合参数的受试者工作特征曲线下面积最大,最佳临界值取0.408时,具有最大Youden指数为0.794,对应的准确性、灵敏度、特异度分别是0.919、0.909、0.923。结论 颈动脉体瘤术前在头颈部CTA图像上显示的肿瘤径线、Shamblin分型以及供血动脉数量,可评估术中出血情况,相比单一参数,联合参数的诊断效能更高。

Value of Head and Neck CT Angiography in the Clinical Evaluation of Intraoperative Bleeding Volume of Carotid Body Tumours

Objective To investigate the value of head and neck CT angiography(CTA)in the evaluation of intraoperative hemorrhage of carotid body tumours. Methods Head and neck CTA images of 36 patients with carotid body tumours confirmed by pathology were retrospectively analyzed.Patients were divided into two groups based on the intraoperative bleeding volume:<500 ml and≥500 ml groups.The patient’s age,sex,Shamblin classification,size of the lesion,number of blood supply arteries,course of the disease,plain scan,and enhanced CT value between two groups were compared and analyzed.Logistics regression equation was established based on the CTA parameters with significant differences between the two intraoperative bleeding volume groups,and combined parameter was acquired.The receiver operating characteristic curve was established based on CTA single and combined parameters. Results The bleeding volume during the operation of carotid body tumors was significantly correlated with the age of patients(P=0.019),the maximum diameter of tumours on axial images(P=0.003),the maximum upper and lower diameters(P=0.004),Shamblin classification(P=0.012),and number of blood supply arteries(P<0.001).The area under the receiver operating characteristic curve of the number of feeding arteries,the maximum diameter of axial images,maximum upper and lower diameters,Shamblin classification,and combined parameters were 0.865,0.781,0.806,0.766,and 0.927,respectively.When the optimal critical value was 0.408,the Youden index was 0.794,and the corresponding accuracy,sensitivity,and specificity were 0.919,0.909,and 0.923,respectively. Conclusions Preoperative head and neck CTA can be used to evaluate the intraoperative blood loss.Combined parameters has the best diagnostic performance compared with single parameters.