CT血流动力学用于乳腺癌诊断的受试者工作特性曲线分析

ROC Analysis of CT Hemodynamics in the Diagnosis of Breast Cancer

目的应用临床流行病学受试者工作特性曲线(ROC)对CT组织灌注用于乳腺癌的诊断价值进行评估。资料与方法对81例(84个)体检或钼靶发现乳腺占位性病变者行MSCT组织灌注扫描,由去卷积法得出血流动力学参数[血流量(BF),平均通过时间(MTT),血容量(BV)],按病理结果的良、恶性分组,行统计学检验。比较BF、MTT、BV相应的ROC特征,确定各参数的诊断价值。结果乳癌组的BF为(0.735±0.440)ml·min-1·ml-1,MTT为(22.771±7.647)s,BV为0.234±0.082;良性组的BF为(0.466±0.527)ml·min-1·ml-1,MTT为(26.712±12.934)s,BV为0.179±0.117。BF、BV在乳腺癌和良性病灶之间的差异有统计学意义。BF在判断乳腺良恶性病变时曲线下面积(AUCROC)最大,为0.832±0.086,BV的AUCROC为0.695±0.092,两者差异无统计学意义。MTT的AUCROC最小,为0.473。BF临界值为0.381ml·min-1·ml-1时,诊断乳腺癌的敏感性为82.3%,特异性为73.2%,阳性似然比为3.071,阴性似然比为0.242;BV临界值为0.190时,敏感性为73.3%,特异性为56.5%,阳性似然比为1.685,阴性似然比为0.473。结论CT血流动力学参数(BF\BV)对乳腺癌的诊断有应用价值,但尚不能作为单一指标肯定或否定乳腺癌的诊断。

Objective To evaluate the diagnostic value of CT pefusion in breast cancer by clinical epidemiologieal method of ROC （receiver operating characteristic curve）analysis. Materials and Method 81 cases with breast mass found by health examination or mammography received MSCT（ multisliee spiral CT） perfusion, then hemodynamie parameters （ blood flow, BF; mean transit time, MTT; blood volume, BV） were calculated by deconvolution arithmetic. According to the pathologic results, two groups of benign and malignant were classified, Statistical test was performed between them. Then ROC character of BF, MTT, BV was compared, and the diagnostic value of the hemodynamic parameters were confirmed. Result In the malignant group, BF was （0.735 ±0.440） ml· min ·^- 1 ·ml ^-1, MTT was （ 22.771 ± 7.647 ） s, and BV was 0. 234 s 0. 082. While in the benign group, the BF was （ 0. 466 ± 0. 527 ）ml· min ·^- 1 ·ml ^-1 , MTT was （26.712 ± 12.934）s, and BV was 0. 179±0. 117. As for BF and BV, there was significant difference between the two groups. When the hemodynamie parameters were used to discriminate the breast lesions, area under the ROC curve （ AUC^ROC ） value of BF was 0.832 ± 0. 086, it was the maximum. AUC^ROC value of BV was 0. 695 ± 0.092, there was no significant difference between them. AUC^ROC value of MTT was 0.473 ±0. 102, it was minimum; as the threshold of BF was 0.381ml· min ·^- 1 ·ml ^-1 , the sensitivity was 82.3%, the specificity was 73.2% , the positive likelihood ratio was 3.071, the negative likelihood ratio was 0.242 ; as the threshold of BV was 0. 190, the sensitivity was 73.3% , the specificity was 56.5%, the positive likelihood ratio was 1. 685, the negative likelihood ratio was 0.473. Conclusion CT hemodynamie parameters （ BF and BV） have certain diagnostic value in breast cancer, but BF or BV can not be single index to confirm or deny the diagnosis of breast cancer.