基于CT平扫的彩色编码图对自发性孤立性肠系膜上动脉夹层初筛的价值

Color-Coded Imaging Based on CT Plain Scan in Preliminary Screening of Spontaneous Isolated Superior Mesenteric Artery Dissection

目的探讨基于CT平扫的彩色编码图在发现自发性孤立性肠系膜上动脉夹层(SISMAD)中的价值。方法由两名具有不同专业水平的观察者对经CT血管造影(CTA)证实的19例SISMAD和15名对照组的CT平扫图像和经彩色编码处理后的CT平扫图像(彩色编码图)进行观察和分析,来评估彩色编码图在SISMAD发现和诊断中的价值。结果两名诊断医师采用CT平扫图像诊断SISMAD的敏感度分别为42.10%、31.58%,特异度分别为93.33%、80.00%,准确率分别为64.71%、52.94%,受试者工作特征曲线(ROC)曲线下面积(AUC)分别为0.677、0.558;两名诊断医师采用彩色编码图诊断SISMAD的敏感度均为52.63%,特异度分别为93.33%、86.67%,准确率分别为70.59%、67.65%,AUC分别为0.730、0.696。在SISMAD血栓组中,两名诊断医师采用CT平扫图像诊断SISMAD的敏感度分别为60.00%、40.00%、特异度均为79.31%,准确率分别为76.47%、73.53%。两名诊断医师采用彩色编码图诊断SISMAD的敏感度均为80.00%,特异度分别为79.31%、75.86%,准确率分别为79.41%、76.47%。彩色编码图对低年资放射诊断医师诊断信心的提高有着显著的统计学意义(P<0.05)。结论基于CT平扫的彩色编码图在一定程度上可以提高肉眼对病变影像的辨识度,进而有助于SISMAD的发现。并且,使用彩色编码图可以有效地提高影像诊断医师诊断SISMAD的信心、准确率及提高观察者间的一致性,特别是对于假腔内有血栓形成的SISMAD。

Objective To evaluate the value of color-coded imaging based on CT plain scan in the detection of spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods Two observers with different levels of expertise analyzed the data,including the CT plain images and the CT scan images processed by color coded(referred to color-coded imaging)of 19 SISMAD cases and 15 control group cases confirmed by CTA,in order to evaluate the value of color-coded imaging in the detection and diagnosis of SISMAD.Results The sensitivity,specificity,accuracy and the area under ROC curve(AUC)of two physician using CT plain scan in diagnosing SISMAD were 42.10%、31.58%,93.33%、80.00%,64.71%、52.94%and 0.677、0.558,respectively.The sensitivity,specificity,accuracy and the area under ROC curve(AUC)of two physician using color-coded imaging in diagnosing SISMAD were 52.63%,93.33%、86.67%,70.59%、67.65%and 0.730、0.696,respectively.In the SISMAD thrombosis group,The sensitivity,specificity and accuracy of two physician using CT plain scan in diagnosing SISMAD were 60.00%、40.00%,79.31%,76.47%、73.53%,respectively.The sensitivity,specificity and accuracy of two physician using color-coded imaging in diagnosing SISMAD were 80.00%,79.31%、75.86%,79.41%、76.47%,respectively.The increase in diagnostic confidence(between the AUC areas)was statistically significant(P<0.05)for the radiology resident.Conclusion The color-coded imaging based on CT plain scan can improve the recognition degree of human eyes to the lesion image to a certain extent,which is conducive to the discovery of SISMAD.In addition,the use of color-coded imaging can improve the diagnostic confidence,accuracy and inter-observer agreement of the physicians,in particular of SISMAD patients with pseudolumen thrombosis.