多层螺旋CT在胃肠道淋巴瘤中的鉴别价值及与TNM分期的相关性研究

目的探讨多层螺旋CT(MSCT)在胃肠道淋巴瘤中的鉴别价值及与TNM分期的相关性。方法选取2017年1月至2020年5月间上海市普陀区人民医院收治的58例胃肠道淋巴瘤患者为A组,另选取同期52例进展性胃癌患者为B组,均接受MSCT扫描检查。比较两组患者及A组内不同TNM分期患者MSCT扫描参数差异,采用受试者工作特征曲线(ROC)分析MSCT扫描参数对胃肠道淋巴瘤的鉴别诊断价值,采用Spearman相关分析MSCT扫描参数与TNM分期的相关性。结果两组患者肿瘤部位、黏膜破坏、胃腔狭窄、密度分布和强化程度比较,差异均有统计学意义(均P <0.05)。A组患者图像客观噪声小于B组,信噪比大于B组,差异均有统计学意义(均P <0.05)。A组患者图像客观噪声随TNM分期升高而降低,信噪比随TNM分期升高而升高;Ⅲ期和Ⅳ期患者的图像客观噪声和信噪比均与Ⅰ期存在差异,差异均有统计学意义(均P <0.05)。ROC曲线分析显示,图像客观噪声和信噪比鉴别诊断胃肠道淋巴瘤与进展性胃癌的AUC分别为0.822和0.823,具有一定准确性。以ROC曲线靠左上方约登指数最大切点为最佳临界值,该点图像客观噪声为67.2%和90.4%,信噪比为63.8%和92.3%,具有一定鉴别诊断价值。进一步ROC曲线显示,联合检查鉴别诊断AUC为0.865,敏感度和特异度为81.0%和93.5%,均高于单项检查,提示联合鉴别诊断价值较高。Spearman相关分析显示,图像客观噪声与胃肠道淋巴瘤TNM分期呈负相关,信噪比与胃肠道淋巴瘤TNM分期呈正相关,差异均有统计学意义(P <0.05)。结论多层螺旋CT用于胃肠道淋巴瘤的辅助鉴别诊断效果较好,且CT扫描参数对判断TNM分期具有重要意义。

Significance of multi-slice CT in the differential diagnosis of gastrointestinal lymphoma and its correlation with TNM staging

Objective To explore the value of multi-slice spiral CT( MSCT) in the differential diagnosis of gastrointestinal lymphoma and its correlation with tumor node metastasis( TNM) staging.Methods The clinical data of 58 patients with gastrointestinal lymphoma were retrospectively selected as group A and those of 52 patients with progressive gastric cancer were selected as group B at Shanghai Putuo District People’s Hospital from January 2017 to May 2020. MSCT scan was performed in all patients. Differences in MSCT scan parameters were compared between the two groups and among patients of different TNM stages in group A. Significance of multi-slice CT in the differential diagnosis of gastrointestinal lymphoma was analyzed using receiver operating characteristic curve( ROC). The relationship between MSCT scan parameters and TNM staging was using Spearman correlation analysis. Results There were statistically significant differences in tumor location,mucosal destruction,gastric cavity stenosis,density distribution,and degree of enhancement between the two groups( all P < 0. 05). The objective image noise was smaller in group A than in group B,and the signal-to-noise ratio was greater than in group B( all P < 0. 05). The objective image noise was smaller decreased in group A with the increase of TNM staging,and the signal-tonoise ratio increased with the increase of TNM staging. There was a significant difference in objective image noise and the signal-to-noise ratio among patients with stage III and IV gastrointestinal lymphoma and patients with II gastrointestinal lymphoma( all P < 0. 05). The ROC curve showed AUC of objective image noise and signal-to-noise ratio for the differential diagnosis of gastrointestinal lymphoma was 0. 822 and0. 823,respectively. When the largest point of tangency to Youden index above ROC curve was considered as the optimal critical value,the objective image noise at this point was 67. 2% and 90. 4% and signal-tonoise ratio was 63. 8% and 92. 3% with certain differential diagnostic value. Further,ROC curve revealed that AUC for the combined examination was 0. 865 and the sensitivity and specificity was 81. 0% and93. 5%,respectively,which was higher than that of single detection. Spearman relationship analysis showed that the optimal critical value was significantly negatively associated with TNM staging in gastrointestinal lymphoma( all P < 0. 05),while the signal-to-noise ratio was significantly positively associated with TNM staging in gastrointestinal lymphoma( P < 0. 05). Conclusion Multi-slice spiral CT shows good efficacy in the auxiliary differential diagnosis of gastrointestinal lymphoma,and CT scan parameters are of great significance for the evaluation of TNM staging.