胰腺癌血管侵犯的不同CT诊断标准的研究

目的:研究胰腺癌血管侵犯的不同CT诊断标准的优劣。材料和方法:回顾性收集我院经多层螺旋CT三期动态增强扫描并经手术病理证实为胰腺导管细胞癌的36例患者。CT轴位图像结合CTA(以MIP和VR方法重建)以及多平面重建(MPR)分别对这些血管以Loyer和Lu血管分级CT标准进行分级,并和手术结果进行对照,分别作出受试者工作特性曲线(ROC),比较曲线下面积的差异。另外,运用Lu的CT诊断标准分别评价胰周动脉和静脉受侵的准确性、灵敏度、特异度、阳性预测值、阴性预测值、Youden指数,研究Lu的CT诊断标准对动静脉分级的差异。结果:Loyer和Lu的CT诊断标准所得的灵敏度、特异度分别为84.5%、86.0%、81.4%、91.8%,两个诊断标准的ROC曲线下面积分别为0.886、0.912,经统计学检验无明显差异。应用Lu的CT诊断标准,胰周动静脉受侵的阳性预测值分别为57.1%和71.0%。结论:分别以Loyer和Lu血管分级CT标准对胰腺癌胰周血管侵犯进行分级,两者的诊断价值相同,Lu的CT诊断标准的最佳诊断分界点应在90°-180°之间,此外,它对胰周动脉的价值要比静脉差。

Different CT Diagnostic Criteria for Peripancreatic Vascular Invasion in Pancreatic Carcinoma

Purpose: To compare different multislice spiral CT(MSCT)diagnostic criteria for peripancreatic vascular invasion in pancreatic carcinoma with ROC method.Materials and Methods:37 patient with pancreatic carcinoma confirmed by surgery-pathology were examined by MSCT preoperatively. In our study, the peripancreatic major vessels include superior mesenteric artery, celiac artery, hepatic artery, splenic artery, superior mesenteric vein, splenic vein and portal vein. The receiver operating characteristic curves(ROC) are drawed according to Loyer and Lu CT diagnostic criteria for peripancreatic major vascular invasion. The areas under the curves are compared.Furthermore, we evaluate the values of Lu CT diagnostic criteria in grading peripancreatic arterial and venous invasion differently.Results:The areas under ROC curves(AUC) for Loyer and Lu CT diagnostic criteria were 0.886 vs 0.912, but there were not significantly different in statistics. With Lu CT diagnostic criteria, the positive predictive values of arterial and venous invasion were 57.1% and 71.0%. Conclusion:The diagnostic values of Loyer and Lu CT diagnostic criteria for peripancreatic vascular invasion had no significantly statistical difference. The Lu CT diagnostic criteria was not very appropriate to evaluate peripancreatic venous invasion.