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中国癌症防治杂志

中国癌症防治杂志 ›› 2015, Vol. 7 ›› Issue (3): 206-209.doi: 10.3969/j.issn.1674-5671.2015.03.14

• 临床研究 • 上一篇    下一篇

MDCT动态增强扫描测量肝癌与膈肌交界面弓弦比对膈肌侵犯的诊断价值

  

  1. 广西医科大学附属肿瘤医院影像中心；广西医科大学研究生学院
  • 出版日期:2015-06-25 发布日期:2015-07-13
  • 通讯作者: 苏丹柯 Sudanke33@sina.com
  • 基金资助:

    广西科学研究与技术开发计划资助项目（桂科攻1355005-3-1）；广西医疗卫生适宜技术研究与开发资助项目（S201301-08）

MDCT measurement of the ratio of arch distance to maximum tumor diameter as a method for detecting diaphragmatic invasion in hepatocellular carcinoma

  • Online:2015-06-25 Published:2015-07-13

PDF (PC)

572

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被引次数

17

摘要：

目的 探讨MDCT动态增强扫描不同期相测量肝癌与膈肌交界面弓弦比对膈肌侵犯的诊断价值。方法 回顾性分析本院影像学检查提示癌灶与邻近膈肌关系密切的肝癌患者90例。经手术及病理检查证实53例无膈肌侵犯，37例有膈肌侵犯。分别测量3个期相（平扫、增强扫描动脉期及增强扫描静脉期）CT图像中的弓长（肝癌与膈肌交界面长度）、弦长（与弓长大致平行的肿瘤最大径线），并计算弓弦比。通过分析3个期相所测弓弦比对肝癌膈肌侵犯的受试者工作特征（receiver operating characteristic，ROC）曲线，评价其诊断效能并确定诊断阈值。结果 无膈肌侵犯与膈肌侵犯在平扫、增强扫描动脉期及增强扫描静脉期所测弓弦比值的差异均有统计学意义（P均＜0.05），ROC曲线示平扫、增强扫描动脉期及增强扫描静脉期的曲线下面积（area under the curve，AUC）分别为0.814、0.769、0.893，Z检验示增强扫描静脉期与平扫、增强扫描静脉期与增强扫描动脉期的AUC之间的差异均有统计学意义（P均＜0.05）。取增强扫描静脉期所测弓弦比的阈值为1.07时，其诊断膈肌侵犯的敏感性为89.2%，特异性为84.9%。结论 MDCT动态增强扫描静脉期图像测量肝癌与膈肌交界面弓弦比可以作为评估癌灶侵犯膈肌的一种简便而准确的方法。

关键词: 肝肿瘤, 计算机体层摄影, 膈肌, 膈肌侵犯, 诊断

Abstract:

Objective To develop a noninvasive technique for evaluating diaphragmatic invasion using routine preoperative dynamic enhanced MDCT. Methods This retrospective study involved 90 patients with histopathologically proven hepatocellular carcinoma and in whom multiphasic MDCT indicated that the tumor was close to the diaphragm. The length of the interface between the primary tumor and neighboring structures（arch distance） as well as the maximum tumor diameter were measured from the images， and the ratio of arch distance to maximum tumor diameter was calculated. Ratios were analyzed using receiver operating characteristic （ROC） curves. Results In 3 phases of dynamic contrast-enhanced MDCT（plain，arterial and venous），the ratio of arch distance to maximum tumor diameter was significantly higher for lesions showing diaphragmatic invasion than for those not showing diaphragmatic invasion. The area under the ROC curve for diagnosing diaphragmatic invasion was 0.893 in the venous phase，0.769 in the arterial phase and 0.814 in the plain phase.With a cut-off of 1.07，using the technique in the venous phase allowed diagnosis of diaphragmatic invasion with a sensitivity of 89.2% and specificity of 84.9%. Conclusion Measurement of the ratio of arch distance to maximum tumor diameter in the venous phase of MDCT is a simple and effective noninvasive technique for detecting diaphragmatic invasion.

Key words: Liver neoplasm, Computed tomography, Diaphragm, Diaphragmatic invasion, Diagnosis