ROC曲线图分析内镜逆行胰胆管造影、磁共振胰胆管显影和CT对胆胰疾病的诊断价值

Diagnostic value of ERCP,MRCP and CT in pancreaticobiliary diseases by the analysis of ROC curve

目的评价内镜逆行胰胆管造影(ERCP)和磁共振胰胆管造影(MRCP)和CT单独或联合应用对胆胰疾病的诊断价值及三者的一致性和互补性。方法回顾性分析424例行ERCP、CT和MRCP检查患者的临床资料,采用同步盲法和ROC曲线比较ERCP、CT和MRCP对胆胰疾病诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值;分析三者的互补性和一致性。结果分析结果显示ERCP、MRCP和CT的Az值(Az值为下面积)分别为0.9281±0.0455,0.8833±0.0400和0.8687±0.0168。对胆胰疾病的诊断,ERCP诊断正确率为93.86%(398/424),显著高于MRCP的85.06%(131/154)和CT的79.45%(116/146)(χ2=15.64,P<0.05)。ERCP、MRCP和CT三种方法同时检查,其诊断准确性达96.23%(102/106),明显高于ERCP+MRCP(84.96%,96/113,χ2=8.02,P<0.05)或ERCP+CT(86.99%,127/146,χ2=6.32,P<0.05)两种方法同时检查的诊断准确性。7例胰腺癌和6例慢性胰腺炎ERCP、MRCP和CT诊断的一致性分别是4和3例,三者结合均明确诊断。结论 ERCP对胆胰疾病诊断的准确性明显高于MRCP和CT,三者结合可提高胆胰疾病的诊断率,特别对胰腺癌和慢性胰腺炎,ERCP、MRCP和CT具有一定的一致性和很好的互补性。

Objective To evaluate diagnostic value of ERCP, MRCP and CT in pancreaticobiliary diseases and their complementary roles. Methods The clinical data of 424 patients checked by ERCP, CT and MRCP were analyzed for the further comparison of sensitivity, specificity, accuracy, positive prediction values, negative prediction values, uniformity and complementarity of ERCP, CT and MRCP in the diagnosis of pancreaticohiliary diseases by using synchronized and blind method and receiver operating characteristic curve （ROC curve）. Results The analysis of ROC curve showed that the areas under the curve of ERCP, MRCP and CT were 0.9281 ±0. 0455, 0. 8833 ±0. 0400 and 0. 8687 ±0.0168 respectively, the diagnostic accuracy of ERCP was 93.86% （398/424） , significantly higher than MRCP 85.06% （131/154） and CT 79.46% （116/146） （P 〈 0.05）. If evaluated by the combination of ERCP, MRCP and CT simultaneously, the diagnostic accuracy was 96.23% , which was significantly higher than the combination of ERCP and CT or MRCP and CT simultaneously （P 〈 0.05 ）. In 7 pancreatic cancer patients and 6 chronic pancreatitis patients checked by ERCP, MRCP and CT, three kinds of test results of 4 pancreatic cancer patients and 3 chronic pancreatitis patients were consistent. All cases could be diagnosed definitely by using ERCP, MRCP and CT were used simultaneously. Conclusions The diagnostic accuracy of ERCP for pancreaticobiliary diseases is significantly higher than MRCP and CT. The combination of ERCP, MRCP and CT can improve the diagnostic accuracy, especially for pancreatic cancer and chronic pancreatitis, and show good consistency and complementarity.