腮腺CT影像报告与数据系统的初步研究

Parotid CT imaging reporting and data system:A preliminary study

目的:初步建立腮腺CT影像报告与数据系统(Parotid Imaging Reporting and Data System,PI-RADS),并探讨其临床应用价值。方法:纳入2013年1月至2016年12月间因腮腺肿物就诊于北京大学口腔医院并进行手术治疗的病例,回顾性评估所有病例的影像资料,获取相关影像特征,评估肿瘤恶性风险概率,并分为6个等级(1级,正常腮腺;2级,基本确定为良性病变或肿瘤;3级,无明确恶性病变证据但不能确定为良性病变;4级,怀疑为恶性肿瘤病变但证据不充分;5级,恶性肿瘤影像征象较充分;6级,有恶性肿瘤病理学证据)。结果:共纳入腮腺肿物病例897例次,其中良性病变905例次、恶性肿瘤98例次,影像诊断为2级、3级、4级和5级的病变中,恶性肿瘤的构成比分别为0.4%、5.7%、35.5%和96.7%,随PI-RADS分级呈逐渐增高趋势(Z=-15.579,P<0.001)。相邻等级[2级与3级(χ^2=12.048,P=0.001)、3级与4级(χ^2=75.231,P<0.001)、4级与5级(χ^2=32.266,P<0.001)]之间的恶性构成比差异有统计学意义。Cohen’s Kappa检验表明两位研究者分级诊断具有中度一致性(κ=0.614,P<0.001,95%CI:0.569~0.695)。结论:应用影像诊断分级方法对腮腺肿瘤性疾病的诊断和临床治疗有一定的帮助。

Objective:To establish a Parotid Imaging Reporting and Data System(PI-RADS)for CT diagnosis of the parotid gland neoplasms and to investigate the clinical applicable value and feasibility of PI-RADS.Methods:Patients who had been diagnosed with primary parotid gland neoplasms and had received surgical treatments in Peking University School and Hospital of Stomatology during the period of January 2013 to December 2016 were included in this study.The diagnoses were confirmed by the postoperative pathological examinations in all the patients.The CT imaging data of all patients were retrospectively reviewed and analyzed by two readers in consensus.Imaging characteristics related to the parotid neoplasms were extracted and quantified.Based on comprehensive analysis of the imaging characteristics,the probabilities of the benign and malignant neoplasms were evaluated and classified into six grades,PI-RADS 1-6(PI-RADS 1:normal parotid gland;PI-RADS 2:confidently benign lesions;PI-RADS 3:probably benign lesions without confirmed evidence of malignancy;PI-RADS 4:suspected malignancy without sufficient evidence of malignancy;PI-RADS 5:confidently malignant lesions;PI-RADS 6:lesions with confirmed pathological evidence of malignancy).Results:A total of 897 patients with 1003 parotid lesions were included.The lesions included 905 benign and 98 malignant lesions.The proportions of the malignancies in PI-RADS 2,PI-RADS 3,PI-RADS 4 and PI-RADS 5 according to the two readers in consensus were 0.4%,5.7%,35.5%and 96.7%respectively.The overall Cohen’s Kappa test showed medium consistency between the two independent researchers(κ=0.614,P<0.001,95%CI:0.569-0.695).Pearson Chi-square test showed that the proportions of malignancies increased with the diagnostic PI-RADS grades(Cochran-Armitage trend test,Z=-15.579,P<0.001).The results of Pearson Chi-square tests showed significant differences between the grades[PI-RADS 2 and 3(χ^2=12.048,P=0.001);PI-RADS 3 and 4(χ^2=75.231,P<0.001);PI-RADS 4 and 5(χ^2=32.266,P<0.001)].Conclusion:PI-RADS can be used to evaluate the risk of malignancy and will be helpful to improve the imaging diagnosis and clinical treatment of paro-tid gland neoplasms.