Sun Pengtao, Li Xinbao, Wang Lingling, Wang Rengui, Du Xuechao
Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2022 Apr;12(4):2321-2331. doi: 10.21037/qims-21-976.
Because few studies have focused on the correlation between computed tomography (CT) signs and tumor grade in pseudomyxoma peritonei (PMP), we evaluated predictive value of abdominal enhanced CT in identifying high- . low-grade cases.
In all, 75 patients diagnosed with PMP after surgery were consecutively recruited. The preoperative enhanced CT images were retrospectively analyzed for ascites, hepatic scalloping, omental and peritoneal lesion appearance, intralesional calcification and septa, and peripheral organ involvement. Logistic regression models were applied to analyze the relationship of CT signs with PMP grade. Receiver operating characteristic curves were generated to evaluate the potential utility of CT signs in detecting high-grade PMP.
Massive ascites (P=0.017) and peritoneal solid nodules (P<0.001) were more common in high-grade cases. Multivariate logistic regression identified massive ascites [odds ratio (OR) =4.389, 95% confidence interval (CI): 1.210-15.921; P=0.025] and peritoneal solid nodules (OR =19.932, 95% CI: 3.560-111.596; P<0.001) as independent predictors of high-grade PMP. For the 55 patients with hepatic scalloping, the maximum thickness of mucin deposition at the hepatic scalloping wave in high-grade PMP was thinner than that in low-grade PMP (P=0.021). Thickness of mucin deposition at the hepatic scalloping wave (OR =0.346, 95% CI: 0.148-0.809; P=0.014) was an independent predictor of high-grade PMP, with a cutoff value of 18.6 mm. Cancer antigen 125 (CA125) combined with CT signs was significantly better at diagnosing high-grade PMP than was CA125 alone in both the overall patients [area under the ROC curve (AUC): 0.812 . 0.656; P=0.020] and those with hepatic scalloping (AUC: 0.859 . 0.600; P=0.007).
The CT signs of high-grade PMP significantly differ from those of low-grade PMP, and thus combining CT signs with CA125 may be highly valuable for classifying PMP.
由于很少有研究关注腹膜假黏液瘤（PMP）的计算机断层扫描（CT）征象与肿瘤分级之间的相关性，我们评估了腹部增强CT在鉴别高级别和低级别病例中的预测价值。
连续纳入75例术后诊断为PMP的患者。对术前增强CT图像进行回顾性分析，观察腹水、肝脏扇贝征、网膜和腹膜病变表现、病灶内钙化和分隔以及周围器官受累情况。应用逻辑回归模型分析CT征象与PMP分级的关系。绘制受试者工作特征曲线，以评估CT征象在检测高级别PMP中的潜在效用。
大量腹水（P = 0.017）和腹膜实性结节（P < 0.001）在高级别病例中更常见。多因素逻辑回归分析确定大量腹水[比值比（OR）= 4.389，95%置信区间（CI）：1.210 - 15.921；P = 0.025]和腹膜实性结节（OR = 19.932，95% CI：3.560 - 111.596；P < 0.001）是高级别PMP的独立预测因素。对于55例有肝脏扇贝征的患者，高级别PMP肝脏扇贝波处黏液沉积的最大厚度低于低级别PMP（P = 0.021）。肝脏扇贝波处黏液沉积厚度（OR = 0.346，95% CI：0.148 - 0.809；P = 0.014）是高级别PMP的独立预测因素，截断值为18.6 mm。癌抗原125（CA125）联合CT征象在诊断高级别PMP方面，总体患者中[受试者工作特征曲线下面积（AUC）：0.812对0.656；P = 0.020]以及有肝脏扇贝征的患者中（AUC：0.859对0.600；P = 0.007）均显著优于单独使用CA125。
高级别PMP的CT征象与低级别PMP明显不同，因此将CT征象与CA125相结合对于PMP分级可能具有很高的价值。
