多层螺旋CT对原发性腹膜后肿瘤的评估价值研究

Study on the assessment value of MSCT on primarily retroperitoneal tumor

目的:分析原发性腹膜后肿瘤及肿瘤样病变多层螺旋CT(MSCT)表现,提高MSCT对腹膜后肿瘤诊断能力。方法:观察385例原发性腹膜后肿瘤MSCT图像特点,对照病理结果分析腹膜后肿瘤的临床常见类型及好发部位,并行Fishers或x^(2)检验。结果:经手术或活检病理证实的385例原发性腹膜后肿瘤中良性149例(神经源性肿瘤占39.6%);恶性236例(脂肪肉瘤占60.6%)。MSCT结合多平面重建对腹膜后肿瘤定位准确率为95.7%。脂肪肉瘤好发于肾周围间隙(78例),占该区域肿瘤的78%(78/100);神经源性肿瘤位于脊柱旁(65例),占该区域肿瘤的90.3%(65/72)。MSCT对原发性腹膜后肿瘤良恶性判断灵敏度、特异度和准确率分别为76.5%、91.2%和84.7%;恶性肿瘤不规则形态144例(占72.7%),良性肿瘤54例(占27.3%),两者有统计学差异(x^(2)=20.25,P<0.001);所有良性腹膜后肿瘤与周围组织器官表现为相互推压,无粘连或受侵,而恶性肿瘤与周围组织器官粘连或受侵为83.0%(196/236),两者差异有统计学意义(x^(2)=24.80,P<0.001)。结论:MSCT扫描对腹膜后肿瘤的解剖定位准确性很高,高分化脂肪肉瘤、神经源性肿瘤、畸胎瘤、脂肪瘤等的MSCT表现有一定的特征性。

Objective:To analyze the phenomenon of Multi-slice spiral computed tomography(MSCT)of primary retroperitoneal tumors and tumor-like lesions,and to enhance the diagnostic capability of MSCT on retroperitoneal tumors.Methods:The characteristics of MSCT images of 385 primary retroperitoneal tumors were retrospectively observed,and the clinical common types of retroperitoneal tumors,as well as the most common site of that were analyzed by comparing with pathological results.And fishers test or x^(2) test were applied in this study.Results:In 385 primary retroperitoneal tumors which were confirmed by surgery or biopsy,149 cases were benign(the rate of neurogenic tumor was 39.6%),and 236 cases were malignant(the rate of liposarcoma was 60.6%).The accuracy rate of MSCT with multi-directional reconstruction on the locations of retroperitoneal tumor was 95.7%.The liposarcoma mainly occurred in peripheral clearance of kidney(78 cases)which were 78%of the tumors in this region(78/100).And the neurogenic tumors occurred beside of spine(65 cases),which were 90.3%of the tumors in this region(65/72).And the sensitivity,specificity,accuracy rate of MSCT on judging benignly and malignantly primary retroperitoneal tumor were 76.5%,91.2%and 84.7%,respectively.144 cases were malignant tumor with irregular form which occupied 72.7%of all tumors,and 54 cases were benign tumor which occupied 27.3%of all tumors,and the difference of the rate between benign and malignant tumor was significant(x^(2)=20.25,P<0.001).And the appearance of all of benign retroperitoneal tumor and periphery tissue and organ was mutual push,without adhesion or without invasion,while the adhesion or invasion rate of malignant tumor with periphery tissue and organ was 83.0%(196/236),and the difference of that between the benign and malignant tumor was significant(x^(2)=24.80,P<0.001).Conclusion:MSCT scan has very high accuracy for anatomy location of retroperitoneal tumor,and the MSCT appearances of liposarcoma with high differentiation,neurogenic tumor,teratoma,lipomyoma and others have a certain of characteristics.