摘要
目的以内镜为标准，前瞻性评价320排CT诊断门静脉高压症食管静脉曲张（EV）的能力，并预测EV发生破裂出血风险。方法收集中山大学附属第三医院2009年3至11月69例经临床确诊为肝硬化门静脉高压症患者，进行上腹部320排CT动态增强扫描，在CT检查1周内，均进行内镜检查。由2名有经验的影像科医师（观察者1、2）独立CT阅片，对EV进行诊断并分级为大EV（≥5mm）和小EV（〈5mm）。应用kappa（K）检验比较2位观察者间以及观察者与内镜间诊断EV分级的一致性；并以内镜为标准，计算2位观察者诊断EV的敏感性、特异性、正确性、阳性预测值和阴性预测值。应用相关性分析评价CT测量的EV直径与内镜所见“红色征”的相关性。结果69例患者，内镜诊断EV56例，其中大EV41例、小EV15例。两位观察者诊断EV的一致性较好，K值为0．94。2位观察者与内镜诊断EV分级的一致性也较好，K值均为0．77。观察者1诊断EV的敏感性、特异性、正确性、阳性预测值和阴性预测值分别为95％、69％、87％、93％和75％；观察者2诊断EV的敏感性、特异性、正确性、阳性预测值和阴性预测值分别为93％、77％、87％、95％和71％。但CT诊断大EV的敏感性、特异性、正确性、阳性预测值和阴性预测值，2位观察者均分别达到95％、100％、97％、100％和93％。2位观察者CT诊断的大EV与内镜“红色征”均有较好的相关性，相关系数r分别为0．731（P〈0．01）和0．718（P〈0．01）。结论320排CT可明确诊断EV的严重程度，预测EV发生破裂出血风险。
Objective The objective of this study was to evaluate the performance of 320-row multidetector CT （MDCT） in the detection and grading of esophageal varices and to evaluate the ability of MDCT in predicting the risk of hemorrhage in comparison with upper endoscoy in patients with portal hpyertension. Methods A total of 69 patients , with clinically confirmed portal hypertension, underwent epigastfic triphasic enhancement scans using 320-row MDCT 1 weeks or less before upper endoscopies were performed. Two blinded abdominal imagers retrospectively interpreted all CT images to detect the presence of esophageal varices and divided EV into large EV （≥5 mm ） and small EV （ 〈 5 mm ）. The correlation between CT measurements and endoscopic gTading was assessed by kappa values. With endoscopy as standard, the sensitivity, specifity, accuracy, positive predictive value and negative predictive value of the two radiologists in detection of EV were calculated. Correlations between CT measurements of varix size and red color sign were asscessed by correlation analysis. Results Of the total of 69 patients, 56 patients had esophageal variees, 41 had large EV, and 15 had small EV according to the endoscopic findings. MDCT showed an excellent interobserver reliability with regard to the diagnosis of the EV （ k = 0. 94 ）. Agreement between CT and endoscopy with regard to the grading of EV were excellent （k = 0. 77）. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of＇ radiologist 1 in the detection of EV was 95%, 69%, 87%, 93% and 75% respectively; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of radiologist 2 in the detection of EV was 93% , 77%, 87% , 95% and 71%, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the two radiologists in the detection of large EV was 95%, 100% , 97%, 100% and 93%, respectively. CT variceal grading showed a strong correlation with endoscopic grading for both observers （P 〈 0.01 ）. Correlations between CT measurements of varix size and red color sign were significant in both radiologists with a correlation coefficient r of 0. 731 for radiologist 1 （P 〈0. 01 ） and 0. 718 for radiologist 2 （P 〈 0. 01）. Conclusion 320-row MDCT is useful for the detection and grading of EV, and it is useful in evaluation of EV for predicting a risk of hemorrhage.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第41期2911-2915,共5页
National Medical Journal of China
基金
广东省部产学研合作项目（2008A030201004）
