贲门癌CT检出淋巴结分布的影像学特点

The distribution of position and size of lymph nodes detected by CT in patients with cardiac carcinoma

目的分析贲门癌CT检出淋巴结的部位及大小分布特点。方法对65例根治性手术切除的贲门癌螺旋CT检出淋巴结情况进行回顾性分析。利用PACS工作站进行图像阅读,记录CT检出淋巴结的部位、数目、大小情况。绘制ROC曲线,分析大小指标诊断贲门癌CT检出淋巴结转移的敏感性、特异性。结果贲门癌CT检出淋巴结以贲门周围、小弯侧最多,检出率和检出淋巴结数目构成比分别为No.1:89%和23%,No.2:66%和8%,No.3:92%和25%;胃左动脉旁及腹腔干周围淋巴结检出次之,分别为No.7:54%和7%,No.9:44%和6%;下纵隔内淋巴结检出明显低于腹部,检出率9%～25%,构成比1%～2%。转移组10mm、8mm、5mm及以下的淋巴结分别占检出总数的76.9%、60.3%、24.8%。ROC曲线分析显示,以大小判断CT检出淋巴结是否转移:取5mm时,敏感性90.7%,特异性21.9%;取8mm时,敏感性51.5%,特异性74%;取11mm时,敏感性13.1%,特异性95.8%;曲线下面积Az=0.661。结论贲门癌CT检出淋巴结主要分布在贲门周围及小弯侧,No.7、9、16组次之。贲门癌转移组CT检出淋巴结以小淋巴结为主,8mm及以下的小淋巴结所占比例达60.3%。以大小判断CT检出淋巴结是否转移,无法同时保证高的敏感性与特异性。

Objective To analyze the distributing characteristics and the range of size of lymph nodes （LN） detected by helical computed tomography （CT） in patients with cardiac carcinoma. Methods Helical CT was performed in 65 patients with cardiac carcinoma. Picture archiving and communication system （PACS） was used. The frequency of nodes in each stations and the size of each LN were retrospectively studied. Sensitivity and specificity were evaluated by means of receiver operator characteristic curve （ROC）. Results ①The majority of LNs detected by CT located at pericardia and lesser gastric curvature, followed by left gastric artery and the celiac trunk stations. The detection rate and percentage were No. 1： 89% and23%, No. 2： 66% and 8%, No. 3： 92% and25%, No. 7： 54% and7%, No. 9： 44% and 6%, respectively. TheLNs at lower mediastinum stations were fewer than that of abdominal stations.②Percentages of nodes smaller than 10 mm, 8 mm, 5 mm in size were 76.9%, 60.3%, 24.8% in node metastases group, respectively.③According to ROC analysis, when 5mm, 8mm, 11mm size criterions were applied, the sensitivity and specificity were 90.7% and 21.9%, 51.5% and 74%, 13.1% and 95.8%, respectively （Az=0. 661）. Conclusion ①The majority of lymph nodes in cardiac carcinoma detected by CT locate at abdomen.②Most nodes of cardiac carcinoma with lymph node metastasis have small size, with 〈8 mm＇s accounting for 60.3%. ③It is difficult to obtain both high sensitivity and specificity using size indictor to judge lymph node metastasis detected by CT.