口服泛影葡胺MSCT对非肿瘤性胸段食管破裂的诊断价值

Diagnostic value for patients of non-neoplastic thoracic esophageal rupture by MSCT with oral meglumin diatrizoate

目的:探讨口服泛影葡胺MSCT对非肿瘤性胸段食管破裂的诊断准确率。方法:回顾性分析98例临床怀疑胸段食管破裂且无肿瘤病史患者的临床资料,其中53例口服60%泛影葡胺后行MSCT检查(口服泛影葡胺组),45例直接行MSCT检查(未口服泛影葡胺组)。非肿瘤性胸段食管破裂均经胃镜证实,无食管破裂患者经胃镜证实或随访3个月证实,采用ROC曲线分析评估口服泛影葡胺MSCT对非肿瘤性胸段食管破裂的诊断效能。采用非参数检验(Mann-Whitney U检验)分析MSCT征象与非肿瘤性胸段食管破裂的关系。利用二元Logistic多变量回归分析诊断非肿瘤性胸段食管破裂的可靠征象。结果:非肿瘤性胸段食管破裂36例,无胸段食管破裂62例。口服泛影葡胺MSCT诊断非肿瘤性胸段食管破裂的效能高于未口服泛影葡胺组,ROC曲线下面积分别为0.906、0.681;口服泛影葡胺组与未口服泛影葡胺组比较,明显提高了诊断非肿瘤性胸段食管破裂的阳性预测值(94.1%vs.57.9%)。多因素分析显示,对比剂外溢是诊断非肿瘤性胸段食管破裂的可靠MSCT征象[OR=10.325,95%置信区间(95%CI)(4.673,51.319),P=0.003]。结论:口服泛影葡胺MSCT可提高非肿瘤性胸段食管破裂的诊断准确率,对比剂外溢是最可靠征象。

Objective:To investigate the diagnostic accuracy by MSCT with oral meglumin diatrizoate in patients with non-neoplastic thoracic esophageal rupture.Methods:Ninety-eight patients with suspect thoracic esophageal rupture without tumors were retrospectively analyzed and were divided into two groups,53 patients received MSCT examination with oral administration of 60%meglumin diatrizoate and 45 patients without oral meglumin diatrizoate.All patients with non-neoplastic thoracic esophageal rupture were confirmed by gastroscopy,and those without esophageal rupture were confirmed by gastroscopy or 3-month follow-up.The diagnostic efficacy of oral meglumin diatrizoate MSCT was evaluated by ROC curve.Non-parametric test(Mann-Whitney U)was used to research the relationgship between MSCT signs and non-neoplastic thoracic esophageal rupture.The reliable signs of diagnosis non-neoplastic thoracic esophageal rupture was analyzed by binary logistic multivariate regression.Results:Non-neoplastic thoracic esophagus rupture was found in 36 patients and non-thoracic esophagus rupture in 62 patients.The efficacy for dignosing non-neoplastic thoracic esophageal rupture of MSCT with oral meglumin diatrizoate was higher than that of MSCT without oral meglumin diatrizoate,AUC was 0.906 and 0.681,respectively.The positive predictive value of oral meglumin diatrizoate in the diagnosis was significantly increased(94.1%to 57.9%).Mulariate analysis showed that contrast extravasation was a reliable MSCT sign for diagnosis[OR=10.325,95%CI(4.673,51.319),P=0.003].Conclusion:MSCT with oral meglumin diatrizoate can increase the accuracy of diagnosing non-neoplastic thoracic esophageal rupture,and contrast extravasation is the most reliable sign.