胃癌浆膜外侵犯CT征象分析

目的 探讨多种CT征象对胃癌浆膜外侵犯的诊断价值。方法 回顾性分析2015年1月至2016年12月在马鞍山市人民医院进行胃癌根治性切除术的173例患者的术前CT检查资料。根据手术病理结果有无浆膜外侵犯分为浆膜外侵犯阳性组96例（阳性组）和浆膜外侵犯阴性组77例（阴性组），对比分析亮线征、浆膜面毛糙、索条、膨隆、结节、脂肪浑浊及血管异常等CT征象在两组患者中的差异。结果 阳性组中亮线征、浆膜面毛糙、索条、膨隆、结节、脂肪浑浊及血管异常等CT征象的出现率分别为35.42%、96.88%、86.46%、64.58%、40.63%、68.75%、26.04%，均高于阴性组，差异有统计学意义（P<0.05）。诊断胃癌浆膜外侵犯的CT征象中，亮线征的特异度和阳性预测值最高，分别为97.40%、94.44%，浆膜面毛糙的灵敏度和阴性预测值最高，分别为96.88%、93.88%，浆膜面索条的符合率、比值比和ROC曲线下面积最高，分别为83.24%、12.767、0.828（P<0.001）。多种CT征象联合诊断胃癌浆膜外侵犯的ROC曲线下面积为0.927（P<0.01）。结论 亮线征、浆膜面毛糙、索条、膨隆、结节、脂肪浑浊及血管异常等CT征象对胃癌浆膜外侵犯有诊断价值。浆膜面索条的诊断性能较好，多种CT征象联合可提高诊断的准确性。

Analysis of CT signs ofgastric cancer with extraserosal invasion

Objective To investigate the values of various CT signs in the diagnosis of gastric cancer with extraserosal invasion. Methods The preoperative CT images of 173 patients with gastric cancer, underwent radical gastrectomy in our hospital between Jan 2015 and Dec 2016, were selected and retrospectively analyzed. Based on the operative and pathological findings, all patients were then divided into the positive group with extraserosal invasion (96 cases) and the negative group without extraserosal invasion (77 cases). The diagnostic efficacy of related CT signs, including signs of bright strings, coarseness, stripes, bulges and nodules of serosal surface, perigastric fat haziness and vascular anomaly, between the two groups were analyzed for further comparison. Results The occurrence rates of CT signs of bright strings, coarseness, stripes, bulges and nodules of serosal surface, perigastric fat haziness and vascular anomaly in the positive group were 35.42%, 96.88%, 86.46%, 64.58%, 40.63%, 68.75% and 26.04%, respectively, which were significantly higher than those in the negative group (all P<0.05). Among the above mentioned diagnostic CT signs of extraserosal invasion of gastric cancer, the CT sign of bright strings had the highest specificity (97.40%) and positive predictive value (94.44%), coarse serosal surface had the highest sensitivity (96.88%) and negative predictive value (93.88%), and stripes of serosal surface offered the highest consistent rate, odds ratio and area under ROC curve (83.24%, 12.767, 0.828; P<0.001). Area under the ROC curve of joint diagnosis of multiple CT signs for extraserosal invasion was 0.927 (P<0.001). Conclusions The CT signs of bright strings, coarseness, stripes, bulges and nodules of serosal surface, perigastric fat haziness and vascular anomaly all have diagnostic values for the extraserosal invasion of gastric cancer. The diagnostic performance of stripes of serosal surface might be much better, and combination of multiple CT signs could further improve the diagnostic accuracy.