| 小肠袢聚集对预测腹膜假黏液瘤患者小肠系膜挛缩的CT价值研究 |
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| 引用本文： | 贾红敏,翟喜超,王志群,卫宏江.小肠袢聚集对预测腹膜假黏液瘤患者小肠系膜挛缩的CT价值研究[J].CT理论与应用研究,2021,30(2):183-191. |
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| 作者姓名： | 贾红敏 翟喜超 王志群 卫宏江 |
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| 作者单位： | 航天中心医院(北京大学航天临床医学院)影像科, 北京 100049 |
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| 基金项目： | 中国航天科工集团医疗卫生科研项目（雷替曲塞在腹膜假黏液瘤腹腔热灌注治疗中临床价值分析（2019-LCYL-004））。 |
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| 摘 要： | 目的:探讨CT扫描图像联合多平面重建（MPR）及容积重建（VR）技术在评判小肠袢聚集对预测腹膜假黏液瘤（PMP）患者小肠系膜挛缩中的临床应用价值。方法:回顾性分析2018年1月至2019年12月我院黏液瘤科179例经手术病理证实为腹膜假黏液瘤的患者，其中31例术中证实存在小肠系膜挛缩，148例无小肠系膜挛缩，通过CT轴位、多平面重建、容积重建技术分别进行小肠袢聚集的判定，并进一步预测小肠系膜挛缩的诊断效能，采用单因素logistic回归、ROC曲线及spearman秩相关性分析，P<0.05为有显著统计学差异。结果:采用单因素logistic回归方法分析小肠袢聚集的检出率:VR>冠状位>轴位>矢状位，对系膜挛缩诊断效能的预测:VR>冠状位>轴位>矢状位。采用ROC曲线分析小肠袢聚集对预测小肠系膜挛缩的诊断效能:轴位敏感性58.8%、特异度79.6%、阳性预测值46.5%、阴性预测值86.5%；冠状位敏感性55.9%、特异度89.6%、阳性预测值61.4%、阴性预测值87.1%；矢状位敏感性50.0%、特异度72.6%、阳性预测值35.4%、阴性预测值82.8%；VR敏感性76.5%、特异度78.8%、阳性预测值52%、阴性预测值91.8%。spearman秩相关性分析:通过轴位、冠状位、矢状位、VR对小肠袢聚集的判定与预测小肠系膜挛缩的结果有较高相关性。结论:单一轴位CT图像对于小肠袢聚集的评价效能有限，结合冠状位和VR，有助于提高小肠袢聚集评价的准确性；小肠袢聚集对于预测小肠系膜挛缩的结果有较高相关性；单纯利用小肠袢聚集判定小肠系膜挛缩，敏感度及特异度有限，需要进一步结合其他研究提高术前小肠系膜挛缩的检出率。
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| 关 键 词： | 腹膜假黏液瘤 X线计算机体层摄影术 多平面重建 容积重建 |
| 收稿时间： | 2020-02-19 |
CT Value Study of Small Intestinal Loop Aggregation in Predicting Mesenteric Contracture in Patients with Pseudomyxoma Peritonei |
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| JIA Hongmin,ZHAI Xichao,WANG Zhiqun,WEI Hongjiang.CT Value Study of Small Intestinal Loop Aggregation in Predicting Mesenteric Contracture in Patients with Pseudomyxoma Peritonei[J].Computerized Tomography Theory and Applications,2021,30(2):183-191. |
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| Authors: | JIA Hongmin ZHAI Xichao WANG Zhiqun WEI Hongjiang |
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| Affiliation: | Department of Radiology, Aerospace Center Hospital(Clinical Medicine College of Peking University), Beijing 100049, China |
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| Abstract: | Objective: To investigate the diagnostic value of CT scanning combined with multiplane reconstruction(MPR) and volume reconstruction(VR) for evaluating small intestinal loop aggregation in predicting small mesenteric contracture in patients with pseudomyxoma peritonealis(PMP). Methods: From January 2018 to December 2019, 179 patients with pseudomyxoma peritonei confirmed by surgery and pathology in our hospital were retrospectively analyzed. Among them, 31 cases were confirmed with mesenteric contracture during operation, and 148 cases were without mesenteric contracture. Axial CT, MPR and VR were used to determine the aggregation of small intestinal loops, and to further predict the diagnosis and treatment of mesenteric contracture. Single factor logistic regression, ROC curve and Spearman rank correlation analysis were used to analyze the efficacy, P<0.05 was considered as significant statistical difference. Results: the detection rate of small intestinal loop aggregation was analyzed by univariate logistic regression: VR > coronal > axial > sagittal, and the prediction of diagnostic efficiency of mesangial contracture was VR > coronal > axial > sagittal. ROC curve was used to analyze the diagnostic efficacy of small intestinal loop aggregation in predicting mesenteric contracture: axial sensitivity 58.8%, specificity 79.6%, positive predictive value 46.5%, negative predictive value 86.5%; coronal sensitivity 55.9%, specificity 89.6%, positive predictive value 61.4%, negative predictive value 87.1%; sagittal sensitivity 50.0%, specificity 72.6%, positive predictive value 35.4%, negative predictive value 87.1%, the sensitivity, specificity, positive predictive value and negative predictive value of VR were 76.5%, 78.8%, 52% and 91.8%, respectively. Spearman rank correlation analysis: axial, coronal, sagittal and VR were highly correlated to predict the results of small intestinal mesangial contracture. Conclusion: The single axial CT image has limited effectiveness in the evaluation of small intestinal loop aggregation. Combined with coronal and VR images, it is helpful to improve the accuracy of small intestinal loop aggregation evaluation; There is a high correlation between the small intestinal loop aggregation and the results of predicting mesenteric contracture. The sensitivity and specificity of using the small intestinal loop aggregation to determine mesenteric contracture are limited, so further research is needed to improve the detection rate of preoperative diagnosis of mesenteric contracture. |
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