脾脏良恶性肿瘤的CT增强特征与诊断价值

CT Enhancement Features and Diagnostic Value of Benign and Malignant Spleen Tumors

目的探讨三期增强CT图像诊断脾脏良恶性肿瘤的价值。方法CT成像采用飞利浦128层螺旋CT机。扫描前分三次口服800 mL温开水,采集范围从右膈顶到右肾下极。经肘静脉注射非离子对比剂。在注射后约25~30、60~70和90~120 s开始采集动脉期、门脉期和平衡期图像。应用四格表资料计算诊断的敏感度、特异度和准确度指标。结果37例患者中良性病变21例,恶性病变16例。良性病变中血管瘤较常见,恶性病变中转移瘤和淋巴瘤较常见。CT增强图像诊断脾脏良恶性肿瘤的敏感度、特异度和准确度分别为81.25%、80.95%和81.10%,漏诊率、误诊率、阳性预测值和阴性预测值分别为23.08%、19.05%、76.47%和85.00%。Youden指数是0.62。结论CT增强平衡期的低密度征象可以作为良恶性鉴别诊断的主要特征之一。

Objective To investigate the value of three-phase enhanced CT images in the diagnosis of benign and malignant tumors of the spleen.Methods The CT imaging was performed by using Philips 128-slice spiral CT machine.Before scanning,about 800 mL of warm boiled water was taken orally three times,and the collection range was from the top of the right diaphragm to the lower pole of the right kidney.Non-ionic contrast agents were injected intravenously through the cubital.Images of the arterial phase,portal phase,and equilibrium phase were collected at 25-30 s,60-70 s,and 90-120 s approximately after injection.The data of four-grid table was used to calculate the sensitivity,specificity,and accuracy of the diagnosis.Results Among the 37 patients,there were 21 cases of benign lesions and 16 cases of malignant lesions.Hemangiomas were more common in benign lesions,and metastatic tumors and lymphomas were more common in malignant lesions.The sensitivity,specificity,and accuracy of CT-enhanced images for the diagnosis of benign and malignant spleen tumors were 81.25%,80.95%,and 81.10% respectively,and the rate of missed diagnosis,misdiagnosis,positive predictive value,and negative predictive value were 23.08%,19.05%,76.47%,and 85.00% respectively.The Youden index was 0.62.Conclusion The low-density signs in the equilibrium phase of CT enhancement can be used as one of the main features in the differential diagnosis of benign and malignant diseases.