Chen Chiao-Yun, Wu Deng-Chyang, Kuo Yu-Ting, Lee Chien-Hung, Jaw Twei-Shiun, Kang Wan-Yi, Hsu Jui-Sheng
Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
AJR Am J Roentgenol. 2008 Jun;190(6):1505-11. doi: 10.2214/AJR.07.2940.
The purpose of this study was to evaluate MDCT parameters for differentiating malignant (category T1 and T2) from benign gastric ulcers and to evaluate the performance characteristics of these predictors with optimal cutoff points determined in receiver operator characteristic analysis.
The subjects were 26 patients with gastric cancer (11 with T1 lesions, 15 with T2 lesions) and 26 patients with benign gastric ulcer. MDCT and virtual gastroscopic findings were analyzed according to four qualitative criteria: ulcer shape, base, and margin and changes in adjacent folds. The quantitative criteria ulcer size, thickness of the gastric wall around an ulcer, thickness of the enhanced ulcer base, and enhancement around an ulcer were measured on multiplanar reconstruction images. We calculated the sensitivity and specificity of each quantitative criterion. Receiver operator characteristic analysis was used to identify cutoff points yielding optimal sensitivity and specificity for the diagnosis of gastric cancer.
On virtual gastroscopy, ulcer shape and margin and gastric fold changes had sensitivities of 80.8%, 84.6%, and 90.9% and specificities of 76.9%, 73.1%, and 77.8%, respectively, in the diagnosis of gastric cancer. On multiplanar reconstruction images, thickness of the enhanced ulcer base and enhancement around the ulcer had sensitivities of 80.8% and 73.1% and specificities of 100% and 100%.
MDCT combined with virtual gastroscopy and multiplanar reconstruction enhances the morphologic details of gastric ulcers and is a useful way to differentiate malignant (T1 and T2) and benign gastric ulcers.
本研究旨在评估多层螺旋CT（MDCT）参数在鉴别恶性（T1和T2期）与良性胃溃疡中的作用，并通过在接受者操作特征分析中确定的最佳截断点来评估这些预测指标的性能特征。
研究对象包括26例胃癌患者（11例为T1期病变，15例为T2期病变）和26例良性胃溃疡患者。根据溃疡形状、底部、边缘以及相邻皱襞变化这四项定性标准对MDCT和虚拟胃镜检查结果进行分析。在多平面重建图像上测量溃疡大小、溃疡周围胃壁厚度、强化溃疡底部厚度以及溃疡周围强化程度等定量标准。我们计算了每个定量标准的敏感性和特异性。采用接受者操作特征分析来确定对胃癌诊断具有最佳敏感性和特异性的截断点。
在虚拟胃镜检查中，溃疡形状、边缘及胃皱襞变化在胃癌诊断中的敏感性分别为80.8%、84.6%和90.9%，特异性分别为76.9%、73.1%和77.8%。在多平面重建图像上，强化溃疡底部厚度及溃疡周围强化程度的敏感性分别为80.8%和73.1%，特异性均为100%。
MDCT联合虚拟胃镜检查及多平面重建可增强胃溃疡的形态学细节显示，是鉴别恶性（T1和T2期）与良性胃溃疡的有效方法。
