计算机断层门静脉成像联合食管静脉曲张测量在评估食管静脉曲张严重程度和评估食管静脉曲张容积疗效中的应用。

Computed Tomographic Portography with Esophageal Variceal Measurements in the Evaluation of Esophageal Variceal Severity and Assessment of Esophageal Variceal Volume Efficacy.

机构信息

Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610000, China.

West China School of Public Health, West China Forth Hospital, Sichuan University, Chengdu, Sichuan Province, China.

出版信息

Acad Radiol. 2020 Apr;27(4):528-535. doi: 10.1016/j.acra.2019.05.015. Epub 2019 Jul 11.

DOI:10.1016/j.acra.2019.05.015

PMID:31303576

Abstract

RATIONALE AND OBJECTIVES

The aim of our study is to evaluate the severity of esophageal varices (EV), based on the computed tomographic portography (CTP) measurement of EV in the distal esophagus and to assess the prediction value of EV volume.

PATIENTS AND METHODS

A total of 53 EV patients examined by CTP within 4 weeks of upper endoscopy were evaluated, the patients were divided into a nonconspicuous EV group (mild-to-moderate EV, n = 28) and a conspicuous EV group (severe EV, n = 25) according to endoscopy results. The diameter, cross-sectional surface area (CSA), and volume of EV were measured independently using 3D-slicer (Boston) by two experienced abdominal radiologists blinded to endoscopy findings. The averaged values measured by the two observers were used in the final dataset, these indicators' predictive performances were studied by using receiver operating characteristic curve analysis, and the area under the curve (A) and the cutoff values were calculated to distinguish mild-to-moderate from severe EV.

RESULTS

The A values of volume, diameter and CSA in differentiating severe EV were 0.817, 0.794, and 0.784 for observer-1, corresponding values for observer-2 were 0.796, 0.774, and 0.707, there was almost perfect interobserver agreement for all measurements. All indices were larger in the conspicuous group than the nonconspicuous group in both observers (p ≤ 0.01). In the final dataset, application of a 654.0-mm-volume criterion yielded sensitivity, specificity of 96%, 50%, application of a 5.2-mm-diameter criterion yielded sensitivity, specificity of 80%, 75%, and application of a 68.6-mm-CSA criterion yielded sensitivity, specificity of 52%, 93%.

CONCLUSION

The volume of EV could be used as a new effective indictor for evaluating EV, and use of volume, diameter, and CSA of EV based on CTP allows discrimination between mild-to-moderate and severe EV in cirrhotic patients.

摘要

背景和目的

本研究旨在通过 CT 门静脉成像（CTP）测量食管下段静脉曲张（EV），评估 EV 的严重程度，并评估 EV 体积的预测价值。

方法

共评估了 53 例在胃镜检查前 4 周内接受 CTP 检查的 EV 患者，根据胃镜检查结果将患者分为不明显 EV 组（轻度至中度 EV，n=28）和明显 EV 组（重度 EV，n=25）。由两名具有丰富腹部放射学经验的观察者使用 3D-slicer（波士顿）独立测量 EV 的直径、横截面积（CSA）和体积。最终数据集采用两名观察者测量的平均值，使用受试者工作特征曲线分析研究这些指标的预测性能，并计算曲线下面积（A）和截断值，以区分轻度至中度 EV 和重度 EV。

结果

观察者 1 区分重度 EV 的体积、直径和 CSA 的 AUC 值分别为 0.817、0.794 和 0.784，观察者 2 对应的 AUC 值分别为 0.796、0.774 和 0.707，所有测量均具有近乎完美的观察者间一致性。在两名观察者中，明显 EV 组的所有指标均大于不明显 EV 组（p≤0.01）。在最终数据集，应用 654.0-mm3 体积标准的敏感性、特异性分别为 96%、50%，应用 5.2-mm 直径标准的敏感性、特异性分别为 80%、75%，应用 68.6-mm2 CSA 标准的敏感性、特异性分别为 52%、93%。