Coakley Fergus V, Choi Patricia H, Gougoutas Christina A, Pothuri Bhavana, Venkatraman Ennapadam, Chi Dennis, Bergman Antonina, Hricak Hedvig
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Radiology. 2002 May;223(2):495-9. doi: 10.1148/radiol.2232011081.
To determine the accuracy of spiral computed tomography (CT) in the depiction of peritoneal metastases by using surgical findings in patients with ovarian cancer as the standard of reference.
Three independent readers reviewed the preoperative CT scans obtained in 64 patients who underwent primary surgery for ovarian cancer. Readers rated the likelihood of peritoneal metastases on a five-point scale and recorded the presence or absence of ascites, parietal peritoneal thickening or enhancement, and small-bowel wall thickening or distortion. Peritoneal metastases were identified as nodular, plaquelike, or infiltrative soft-tissue lesions in the peritoneal fat or on the peritoneal surface. Area under the receiver operating characteristic curve was calculated for each reader. Interreader agreement was evaluated with the kappa statistic. Descriptive statistical data were determined with dichotomized ratings (1-3 = absent; 4-5 = present).
Areas under the receiver operating characteristic curves for the three readers were 0.95, 0.93, and 0.89. Paired kappa values ranged from 0.75 to 0.91. Reader sensitivity for metastases 1 cm or smaller in maximum diameter (25%-50%) was significantly (P <.05) lower than overall sensitivity (85%-93%). Ascites, parietal peritoneal thickening or enhancement, and small-bowel wall thickening or distortion demonstrated positive predictive values of 72%-93%, with kappa values of 0.12-0.80.
Spiral CT is accurate in the depiction of peritoneal metastases from ovarian cancer, although sensitivity is reduced in patients with tumor implants 1 cm or smaller. Ancillary signs of peritoneal malignancy are limited by low interobserver agreement.
以卵巢癌患者的手术结果为参考标准，确定螺旋计算机断层扫描（CT）在显示腹膜转移瘤方面的准确性。
三位独立的阅片者回顾了64例接受卵巢癌初次手术患者的术前CT扫描图像。阅片者采用五点量表对腹膜转移瘤的可能性进行评分，并记录有无腹水、腹膜增厚或强化以及小肠壁增厚或变形。腹膜转移瘤表现为腹膜脂肪内或腹膜表面的结节状、斑块状或浸润性软组织病变。计算每位阅片者的受试者操作特征曲线下面积。采用kappa统计量评估阅片者之间的一致性。使用二分法评分（1 - 3 = 无；4 - 5 = 有）确定描述性统计数据。
三位阅片者的受试者操作特征曲线下面积分别为0.95、0.93和0.89。配对kappa值范围为0.75至0.91。阅片者对最大直径1 cm或更小转移瘤的敏感度（25% - 50%）显著低于总体敏感度（85% - 93%）（P <.05）。腹水、腹膜增厚或强化以及小肠壁增厚或变形的阳性预测值为72% - 93%，kappa值为0.12 - 0.80。
螺旋CT在显示卵巢癌腹膜转移瘤方面是准确的，尽管对于肿瘤种植灶最大直径1 cm或更小的患者，敏感度有所降低。腹膜恶性肿瘤的辅助征象受观察者间一致性较低的限制。
