胃间质瘤多层螺旋CT影像学特征预测病理NIH危险度分级的可行性分析

The feasibility analysis of multi-slice spiral CT features of gastric stromal tumors in predicting pathological National Institutes of Health risk classification

目的探讨胃间质瘤(GST)多层螺旋CT(MSCT)影像学特征预测病理美国国立卫生研究院(NIH)危险度分级的可行性,为GST患者在治疗前提供影像学依据。方法回顾性收集2014年11月至2021年11月于复旦大学附属中山医院及西南医科大学附属中医医院经手术病理证实为GST患者504例(共计506枚GST)的临床及影像资料,其中男259例,女245例,年龄13~85(60±11)岁。根据病理NIH危险度分级标准,分为低风险组(极低危险度和低危险度,277枚)和高风险组(中危险度和高危险度,229枚)。比较两组间的临床资料及影像学特征的差异性,对差异有统计学意义的影像学指标进行多因素logistic回归分析并筛选出危险因素,采用受试者工作特征(ROC)曲线评价肿瘤长径对危险度分级的预测价值。结果低风险组与高风险组在性别(男/女:131/146比129/100)、消化道出血(有/无:39/238比59/170)、形态(规则/不规则:218/59比95/134)、钙化(有/无:36/241比53/176)、坏死程度(0°/Ⅰ°/Ⅱ°/Ⅲ°:197/61/16/3比58/98/32/41)、溃疡(有/无:32/245比94/135)、生长方式(腔内生长/腔外生长/腔内外生长:102/105/70比44/98/87)、肿瘤位置(胃底/贲门/胃体/胃角/胃窦:98/7/135/12/25比98/6/114/5/6)、供血动脉(有/无:32/245比104/125)、血管样强化(有/无:19/258比88/141)、灶周积液(有/无:0/277比13/216)、灶周脂肪阳性征(有/无:0/277比30/199)、肿瘤最长径[2.82(2.04,3.80)cm比5.93(4.06,8.29)cm]、肿瘤短径[2.31(1.60,2.88)cm比4.40(3.21,6.37)cm]方面差异均具有统计学意义(均P<0.05)。肿瘤最长径(OR=2.08,95%CI:1.35~3.20)和溃疡阳性(OR=2.01,95%CI:1.03~3.92)是危险度分级的危险因素(均P<0.05);肿瘤位置中以胃窦为参照,胃底(OR=7.77,95%CI:2.00~30.24)、胃体(OR=3.93,95%CI:1.03~15.01)是危险度分级的危险因素(均P<0.05)。肿瘤最长径预测肿瘤危险度分级的ROC曲线下面积(AUC)为0.87,最佳临界值、灵敏度和特异度分别为4.98 cm、62.9%、95.3%。结论GST的MSCT征象具有一定特征性,对其术前病理NIH危险度分级有一定的预测价值,能为患者治疗前提供一定的影像学依据。

Objective To investigate the feasibility of multi-slice spiral CT(MSCT)imaging features of gastric stromal tumor(GST)in predicting pathological NIH risk classification,providing imaging basis for patients with GST before treatment.Methods The clinical and CT imaging data of 504 patients(506 GST lesions),259males and 245 females,aged from 13 to 85(60±11)years,with GST confirmed by surgery and pathology collected in the Zhongshan Hospital Affiliated to Fudan University and the Affiliated TCM Hospital of Southwest Medical University.According to pathological NIH risk classification,506 lesions were divided into low risk group(very low and low risk degree,277 lesions)and high risk group(medium and high risk degree,229 lesions).Clinical data and imaging characteristics were compared between two groups.Multivariate logistic regression analysis was performed to screen out independent risk factors for statistically significant imaging indicators.Receiver operating curve(ROC)was used to evaluate the predictive value of tumor length for risk classification.Resulst Between low risk group and high risk group,there were significant differences in gender(male/female:131/146 vs 129/100),gastrointestinal bleeding(present/absent:39/238 vs 59/170),morphology(regular/Irregular:218/59 vs 95/134),calcification(present/absent:36/241 vs 53/176),degree of necrosis(0°/Ⅰ°/Ⅱ°/Ⅲ°:197/61/16/3 vs 58/98/32/41),ulceration(present/absent:32/245 vs 94/135),growth pattern(endophytic/exophytic/mixed:102/105/70 vs 44/98/87),tumor location(fundus/cardia/body/angle/antrum:98/7/135/12/25 vs 98/6/114/5/6),feeding artery(present/absent:32/245 vs 104/125),vascular enhancement(present/absent:19/258 vs 88/141),effusion of around the disease(present/absent:0/277 vs 13/216),positive sign of fat around the disease(present/absent:0/277 vs 30/199),maximum long diameter[2.82(2.04,3.80)cm vs 5.93(4.06,8.29)cm]and short diameter[2.31(1.60,2.88)cm vs 4.40(3.21,6.37)cm]of tumor(all P<0.05).The maximum long diameter of tumor(OR=2.08,95%CI:1.35-3.20)and ulceration positive(OR=2.01,95%CI:1.03-3.92)were independent risk factors of risk classification(all P<0.05).Gastric antrum was used as the reference for tumor location,gastric fundus(OR=7.77,95%CI:2.00-30.24)and gastric body(OR=3.93,95%CI:1.03-15.01)were independent risk factors of risk classification(all P<0.05).The area under curve(AUC)of the maximum long diameter of tumor for predicting risk classification was 0.87,and the optimal critical value,sensitivity and specificity were 4.98cm,62.9%and 95.3%respectively.Conclusions MSCT image features of GST had certain characteristics.MSCT has certain predictive value for pathological NIH risk classification of GST,which can provide certain imaging basis for patients before treatment.