320排CT对肺段切除患者肺血管的评估效能

Efficacy Assessmentof 320-detector Row Computed Tomography for Pulmonary Vasculature of Candidates withPulmonary Segmentectomy

目的对预行肺段切除术患者术前应辨别、评估受累肺血管,探讨320排CT与64排CT评估受累肺血管的效能。方法 56例预行肺段切除术患者术前均行320排CT和64排CT扫描,重建肺血管CT三维图像,识别受累肺段肺动脉和肺段间静脉。2名放射科医师采用5分法独立评估受累肺血管的可视性情况,Kappa检验评估观察者间的一致性。Wilcoxon秩和检验比较320排CT和64排CT评估肺血管可视化效能。此外,由2名胸外科医师术中最终决定受累肺血管的情况,ROC曲线分析CT辨别、评估肺血管情况的效能,继而采用McNemar’s检验比较其敏感性、特异性和准确性。结果 320排CT评估肺血管的可视化评估效能明显高于64排CT,差异有统计学意义(受累肺动脉、受累肺段间静脉均P<0.001);ROC曲线下面积发现对于辨别肺血管评估64排CT和320排CT检查结果差异无统计学意义,但320排CT评估肺段间静脉的特异性和准确性高于64排CT。64排CT和320排CT检查观察者间的一致性均相当满意。结论对于行肺段切除术的患者而言,320排CT对肺血管的评估较64排CT效能更佳。

Objective Identification of the intersegmental veins is essential for patients of segmentecto- my. The purpose of this study was to compare the efficacy of 320-detector row computed tomography （CT） with that of 64-detector row CT for three-dimensional assessment of pulmonary vasculature of can- didates for pulmonary segmentectomy. Methods 56 patients underwent scanning hy both 320-detector CT and 64-detector CT before pulmonary segmentectomy to obtain three-dimensional pulmonary vasculature images, and the arteries and intersegmental veins of the affected segments were identified. Two radiolo- gists assessed the vessels with visual scoring systems independently using a 5 point method and kappa anal- ysis was used to determine interobserver agreement. The Wilcoxon test was used to compare the visual scores for the assessment of the visualization capabilities of the two methods. And then, the final deter- mination of pulmonary vasculature was made by thoracic surgeons during operation, and receiver operating characteristic analysis was performed to compare their efficacy of pulmonary vasculature assessment. Sen- sitivity, specificity and accuracy of either method were also compared by means of McNemar＇s test. Re- suits Visualization scores of 320-detector CT for the pulmonary vessels were significantly higher than those of 64-detector CT （P〈0. 0001 for the affected arteries and P〈0. 0001 for the intersegmental veins）. As for pulmonary vasculature assessment, the areas under the curve showed there was no statistically sig- nificant differences between the two methods, while the specificity and accuracy of intersegemental vein assessment of 320-detector row CT were significantly better than those of 64-detector row CT （P 〈0.05）. Interobserver agreement for the assessment yielded by either method was ahnost perfect for all cases.Conclusion 320-detector row CT has better efficacy than 64-detector row CT on assessment of pulmonary vasculature for candidates for pulmonary segmentectomy.