多层螺旋CT检查对宫颈癌患者淋巴结转移的预测价值

Predictive value of multi-slice spiral CT examination for lymph node metastasis in cervical cancer patients

目的探讨多层螺旋CT检查对宫颈癌患者淋巴结转移的预测价值。方法选取86例宫颈癌患者,均接受多层螺旋CT检查,依据病理检查结果分为转移组和未转移组,比较转移组与未转移组患者多层螺旋CT检查淋巴结图像特征和CT定量参数。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估多层螺旋CT检查对宫颈癌患者淋巴结转移的预测价值;多层螺旋CT检查诊断淋巴结转移的结果与病理检查结果的一致性采用Kappa检验。结果病理检查结果显示,86例宫颈癌患者中,淋巴结转移22例,淋巴结未转移64例。转移组与未转移组患者淋巴结长径、淋巴结短长径比值、淋巴结形态、淋巴结强化表现比较,差异均有统计学意义(P﹤0.05)。多层螺旋CT检查共检出20个转移淋巴结,与病理检查结果的一致性较高(Kappa=0.748),多层螺旋CT检查与病理检查对各部位转移淋巴结的检出情况比较,差异无统计学意义(P﹥0.05)。转移组患者淋巴结短径、淋巴结短长径比值、平扫CT值、动脉期CT值、静脉期CT值、静脉期-造影前相对强化值均高于未转移组,差异均有统计学意义(P﹤0.05)。ROC曲线显示,淋巴结短长径比值、静脉期-造影前相对强化值预测宫颈癌患者淋巴结转移的AUC分别为0.881(95%CI:0.795~0.967)、0.853(95%CI:0.774~0.932),预测价值较高。结论转移淋巴结相较于正常淋巴结会发生明显的形态学改变,多层螺旋CT检查淋巴结短长径比值、静脉期-造影前相对强化值对宫颈癌患者淋巴结转移的预测价值较高。

Objective To analyze the predictive value of multi-slice spiral CT examination for lymph node metastasis in cervical cancer patients.Method A total of 86 cervical cancer patients were selected and underwent multi-slice spiral CT examination.According to the pathological examination results,patients were divided into metastatic group and non metastatic group.The lymph node image features of multi-slice spiral CT and CT quantitative parameters were compared between the metastatic group and non-metastatic group.The receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated,and the predictive value of multi-slice spiral CT examination for lymph node metastasis in cervical cancer patients was evaluated.The consistency between pathological examination results and multi-slice spiral CT examination in diagnosing lymph node metastasis was determined by Kappa test.Result Pathologi-cal examination results showed that among 86 cervical cancer patients,22 cases had lymph node metastasis and 64 cases had no lymph node metastasis.There were statistically significant differences in lymph node length,lymph node short to long diameter ratio,lymph node morphology,lymph node enhancement expression between the metastatic group and non metastatic group(P<0.05).A total of 20 metastatic lymph nodes were detected by multi-slice spiral CT examination,and the consistency between pathological examination results and multi-slice spiral CT examination in diagnosing lymph node metastasis was high(Kappa=0.748).There was no statistically significant difference in the detection of metastatic lymph nodes in various parts between multi-slice spiral CT examination and pathological examination(P>0.05).The lymph node short diameter,lymph node short to long diameter ratio,plain CT value,arterial CT value,venous CT value,and relative enhancement value of venous phase-before visualization in the metastatic group were higher than those in the non-metastatic group,and the differences were statistically significant(P<0.05).The ROC curve showed that the AUC of predicting lymph node metastasis in cervical cancer patients by lymph node short to long diameter ratio and relative en-hancement value of venous phase-before visualization were 0.881(95%CI:0.795-0.967)and 0.853(95%CI:0.774-0.932),respectively,indicating high predictive value.Conclusion Compared with normal lymph nodes,metastatic lymph nodes show significant morphological differences.Multi-slice spiral CT examination of lymph node short to long diameter ratio and relative enhancement value of venous phase-before visualization has higher predictive value for lymph node metastasis in cervical cancer patients.