不同维度影像测量肝硬化自发性门体分流的诊断效能比较

Comparison of Diagnostic Efficacy of Different Dimensional Imaging Measures for Spontaneous Portosystemic Shunting in Cirrhosis

目的 通过影像方法测量肝硬化自发性门体分流(SPSS)患者的分流静脉总直径(TSD)、分流静脉总截面积(TSA)、分流静脉总体积(TSV),比较三种测量方法对肝硬化并发症的诊断效能。方法 回顾性搜集山东大学齐鲁医院德州医院2015年1月至2022年1月107例SPSS患者的临床及影像资料,分别测量分流静脉的TSD、TSA、TSV,分析三者之间的线性关系。分别构建基于三种测量方法预测肝性脑病、门静脉血栓、消化道出血、腹腔积液的受试者工作特征曲线(ROC),分析比较三种测量方法的诊断效能。结果 TSD与TSA、TSV之间均无线性关系(B=0.102、4.176,P均>0.05),TSA与TSV之间存在线性关系(B=9.585,P=0.015)。肝性脑病共46例(42.99%),TSD、TSA、TSV均对肝性脑病诊断效能良好(AUC=0.797、0.817、0.810),三种方法诊断效能的差异无统计学意义(P均>0.05);门静脉血栓共39例(36.45%),TSD、TSA、TSV对门静脉血栓的诊断效能良好(AUC=0.751、0.873、0.862),TSA、TSV的诊断效能均高于TSD(P均<0.05);消化道出血共41例(38.32%),TSD对消化道出血诊断效能不良(AUC=0.581),TSA、TSV对消化道出血的诊断效能良好(AUC=0.761、0.813),TSA与TSV诊断效能的差异无统计学意义(P=0.373);腹腔积液共52例(48.60%),TSD对腹腔积液的诊断效能不良(AUC=0.652),TSA、TSV对腹腔积液的诊断效能良好(AUC=0.753、0.878),TSV诊断效能高于TSA(P=0.049)。结论 影像测量对肝硬化并发症的发生具有较高的预测价值,TSA、TSV均具有较高诊断效能,TSD效能有限。综合考虑操作便捷性等因素,TSA是较为适宜的影像测量方法。

Objective The total SPSS diameter(TSD),Total cross-sectional SPSS area(TSA),and Total SPSS volume(TSV) were measured by imaging methods in patients with spontaneous portosystemic shunting(SPSS),to compare the diagnostic efficacy for the complications of cirrhosis. Methods A retrospective collection of 107 patients from Shandong University Qilu Hospital Dezhou Hospital from January 2015 to January 2022 was conducted. TSD,TSA and TSV of shunt veins were measured respectively, and the linear relationship was analyzed. Receiver operating characteristic curves(ROC curves) were constructed to predict hepatic encephalopathy, portal vein thrombosis, gastrointestinal bleeding and ascites based on three measurement methods, and the diagnostic efficiency of the three methods was analyzed and compared. Results No linear relationship was found between TSD with both TSA and TSV(B= 0.102,4.176,P> 0.05),but the linear relationship between TSA and TSV existed(B= 9.585,P= 0.015).A total of 46 patients(42.99%) with hepatic encephalopathy were diagnosed accurately by TSD,TSA and TSV(AUC=0.797,0.817,0.810),and there was no statistical significance in the diagnostic efficacy of these three methods(P>0.05). A total of 39 cases(36.45%) with portal vein thrombosis were diagnosed accurately by TSD,TSA and TSV(AUC=0.751、0.873、0.862),and the diagnostic efficacy of TSA and TSV were higher than that of TSD(P< 0.05).A total of 41 cases(38.32%) with gastrointestinal bleeding were diagnosed inaccurately by TSD(AUC=0.581),but were diagnosed accurately by TSA and TSV(AUC=0.761、0.813),and there was no statistically significant difference in diagnostic efficacy between TSA and TSV(P=0.373).A total of 52 cases(48.60%) with ascites were diagnosed inaccurately by TSD(AUC=0.652),but were diagnosed accurately by TSA and TSV(AUC=0.753、0.878),and the diagnostic efficacy of TSV were higher than that of TSA(P=0.049). Conclusion Imaging measurement had a high predictive value for the occurrence of cirrhosis complications, with TSA and TSV had high efficacy, while TSD had limited efficacy. Considering the convenience of operation, TSA is a more suitable imaging measurement method.