双源CT双动脉期增强扫描对肝动脉-门静脉瘘的评估价值及风险因素分析

Value of dual-source CT double arterial phases enhanced scan in the evaluation of hepatic artery-portal vein fistula and its risk factors analysis

目的:探讨双源CT双动脉期增强扫描模式对肝动脉-门静脉瘘(HAPVF)的评估价值及风险因素分析。方法:选取HAPVF和非HAPVF患者各60例,分别为HAPVF组和非HAPVF组,行双源CT双动脉期增强扫描,比较2组临床指标及CT征象差异。以DSA为金标准,对比动脉早期、动脉晚期和双动脉期对HAPVF的诊断敏感度、特异度,以及对HAPVF分型的诊断准确率。应用logistic回归分析探讨HAPVF的危险因素,采用ROC曲线评估危险因素预测HAPVF的价值。结果:双动脉期诊断HAPVF的敏感度、特异度、阳性预测值、阴性预测值及分型准确率均明显高于单独2期(均P<0.05)。2组肝癌大小、包膜类型、门静脉癌栓比较,差异均有统计学意义(均P<0.05)。logistic回归分析显示,肝癌大小、包膜类型、门静脉癌栓均是HAPVF的独立危险因素。ROC曲线表明,单因素预测HAPVF效果最好的是包膜类型,其次是门静脉癌栓,再次是肝癌大小。综合多因素联合预测分析显示,肝癌大小+包膜类型+门静脉癌栓预测效果最好。结论:双源CT双动脉期增强扫描模式对HAPVF的诊断敏感度、特异度较高,且在HAPVF分型中具有较好的诊断效果。HAPVF的临床及影像学征象具有一定特点,其中肝癌大小、包膜类型、门静脉癌栓均是HAPVF的独立危险因素,三者联合预测效果最好,能为临床及时诊治提供可靠依据。

Objective:To evaluate the dual-source CT double arterial phases enhanced scan for hepatic artery-portal vein fistulas(HAPVF)and its risk factors analysis.Methods:Sixty patients with HAPVF and sixty patients with non-HAPVF were selected.All patients underwent dual-source CT double arterial phases enhanced scan.The clinical indicators and imaging features were compared between the two groups.DSA findings were used as the gold standards,and the sensitivity and specificity of the early arterial phase,the late arterial phase and the double arterial phases were compared,and the accuracy for HAPVF classification was compared.Logistic regression analysis was applied to explore the risk factors of HAPVF,and ROC curve was used to evaluate the value of the risk factors prediciting HAPVF.Results:The sensitivity,specificity,positive predictive value,negative predictive value and the classification accuracy of the double arterial phases in diagnosis of HAPVF were significantly greater than those of the early and late arterial phases.The tumor size,envelope type and portal vein tumor thrombus were significantly different between the two groups(all P<0.05),and were all independent risk factors for HAPVF revealed by multivariate regression analysis.ROC curve analysis showed the best single-factor predictor was envelope type,then the portal vein tumor thrombus,and last the tumor size.Multifactor combined forecasting analysis revealed that the combined prediction of the three features was the best.Conclusions:Dual-source CT double arterial phases enhanced scan has the high sensitivity and specificity in the diagnosis of HAPVF,and it has a good diagnostic accuracy in HAPVF classification.Clinical indicators and CT findings of HAPVF include certain characteristics,and tumor size,envelope type and portal vein tumor thrombus are independent risk factors.The combined prediction of the three is the best,which provides a reliable and effective basis for timely clinical diagnosis and treatment.