三维超声鉴别良恶性胃溃疡的诊断价值

The diagnostic value of three-dimensional ultrasound for identification of benign and malignant gastric ulcer

目的探讨三维超声技术在鉴别良恶性胃溃疡中的诊断价值。方法收集2014年3月—2015年5月于天津市南开医院收治的胃溃疡患者88例,其中病理证实恶性胃溃疡36例,良性胃溃疡52例。以病理结果作为金标准,比较二维超声、三维超声、胃镜检查的诊断结果,评价3种方法的诊断价值。绘制三维超声主要测量指标(溃疡宽度、深度、周围胃壁厚度)的受试者工作特征(ROC)曲线,确定最佳诊断界值。结果三维超声对恶性胃溃疡的阳性检出率高于二维超声(P=0.002),但与胃镜检查结果比较差异无统计学意义(P=0.453)。三维超声、二维超声、胃镜诊断恶性胃溃疡的敏感度分别为86.11%、58.33%、91.67%,特异度分别100%、100%、96.15%。三维超声测量溃疡宽度、深度、周围胃壁厚度的曲线下面积(AUC)分别为0.750、0.940、0.977,最佳诊断点分别为16.55 mm、8.05 mm、9.90 mm。结论三维超声能更清晰、直观地显示胃溃疡形态学改变,对良恶性胃溃疡的鉴别诊断价值较高,可用于恶性胃溃疡的筛查。

Objective To investigate the value of three-dimension(3D)ultrasound in identification of benign ormalignant gastric ulceration.Methods A total of88patients with gastric ulcer were collected in Tianjin Nankai Hospitalfrom March2014to May2015,including36malignant cases and52benign cases confirmed by pathological results.Resultsof2D ultrasound,3D ultrasound and gastroscope diagnosis were compared,and the diagnostic values of the three methodswere evaluated by the gold standard of pathologic results.Receiver operating characteristic(ROC)curves were plotted for themain measurement indicators(ulcer surface width,ulcer surface depth and thickness of stomach wall)of3D ultrasound.Thebest cut-off value was determined.Results The positive rate of malignant gastric ulcer diagnosed by3D ultrasound wassignificantly higher than that of2D ultrasound(P=0.002),but there was no significant difference between3D ultrasound andgastroscope detection(P=0.453).The diagnostic sensitivities of malignant gastric ulcer were86.11%,58.33%and91.67%for3D ultrasound,2D ultrasound and gastroscope detection respectively.The diagnostic specificities were100%,100%and96.15%respectively.The areas under the ROC curves measured by3D ultrasound were0.750,0.940and0.977for ulcersurface width,ulcer surface depth and thickness of stomach wall.And the best cut-off values of the three indicators were16.55mm,8.05mm and9.90mm.Conclusion The3D ultrasound can show the form and structure of gastric ulcer moreclearly and intuitively,which is valuable for the differential diagnosis of benign gastric ulcer and malignant gastric ulcer,andmay be used for screening malignant gastric ulcer.