多排螺旋 CT 与阴性对比剂与阳性对比剂在胃肠道神经内分泌肿瘤评估中的性能比较。
Performance of Multidetector Computed Tomography and Negative Versus Positive Enteric Contrast for Evaluation of Gastrointestinal Neuroendocrine Neoplasms.
机构信息
From the Department of Abdominal Radiology, University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA.
出版信息
J Comput Assist Tomogr. 2022;46(3):333-343. doi: 10.1097/RCT.0000000000001291. Epub 2022 Mar 4.
BACKGROUND
Routine computed tomography (CT) scans are thought to have poor performance for detection of gastrointestinal (GI) neuroendocrine neoplasms (NENs), which leads to delayed workup. Detection of even 1 bowel tumor can guide diagnostic workup and management. The purposes of this study were to assess the accuracy of multidetector computed tomography (MDCT) and to compare negative versus positive enteric contrast in detecting at least 1 GI tumor per patient with suspected or confirmed diagnosis of a NEN.
METHODS
This retrospective study included 107 patients with intravenous and oral contrast (65 positive, 40 negative, and 2 no oral contrast) abdominopelvic MDCT. Two abdominal radiologists independently analyzed the CTs for detection and localization of bowel NENs. Surgical pathology was considered the reference standard. Analyses included κ and summary statistics, McNemar test, Pearson χ2 test, and Fisher exact test.
RESULTS
Among the 107 CT scans, there were 30 pathology negative studies and 77 studies with positive pathology for GI NEN. Interreader agreement for CT evaluation was substantial (κ = 0.61). At least 1 GI NEN per patient was detected with 51% to 53% sensitivity, 87% to 93% specificity, 91% to 95% positive predictive value (PPV), 42% negative predictive value, and 63% accuracy for each reader, and 57% accuracy when only the concordant (ie, matching) results of the 2 readers were considered. Computed tomography scans with negative enteric contrast had significantly higher sensitivity for concordant results than CTs with positive enteric contrast (58% vs 30%, P = 0.01). Specificity (100% vs 95%, P = 0.5), PPV (100% vs 93%, P = 0.49), negative predictive value (39% vs 39%, P = 0.99), and accuracy (67% vs 51%, P = 0.10) were not significantly different for negative versus positive enteric contrast for the concordant results. There was no significant difference in GI NEN localization between the readers.
CONCLUSIONS
Routine MDCT with either positive or negative enteric contrast can detect at least 1 GI tumor per patient with more than 90% PPV and more than 50% accuracy in patients suspected of GI NEN. Using negative enteric contrast improves sensitivity for GI NEN versus positive enteric contrast. In addition, there is high accuracy in localizing the bowel tumor with positive or negative enteric contrast, which may guide surgery. Radiologists should have heightened awareness that evaluating such scans closely may lead to detection of primary bowel NENs at a higher rate than previously reported.
背景
常规计算机断层扫描（CT）被认为对胃肠道（GI）神经内分泌肿瘤（NEN）的检测效果不佳，这导致了检查的延误。即使发现 1 个肠肿瘤，也可以指导诊断和治疗。本研究的目的是评估多排 CT（MDCT）的准确性，并比较阴性与阳性肠内对比剂在检测疑似或确诊为 NEN 的患者中至少 1 个 GI 肿瘤方面的表现。
方法
本回顾性研究纳入了 107 例接受静脉和口服对比剂（65 例阳性，40 例阴性，2 例未行口服对比剂）的腹盆腔 MDCT 检查的患者。2 位腹部放射科医生独立分析 CT 以检测和定位肠 NEN。手术病理被认为是参考标准。分析包括κ和汇总统计、McNemar 检验、Pearson χ2 检验和 Fisher 确切检验。
结果
在 107 次 CT 扫描中，有 30 次病理学阴性研究和 77 次病理学阳性的胃肠道 NEN 研究。CT 评估的两位读者间的一致性为中等（κ=0.61）。对于每位患者，至少有 1 个 GI NEN 被检测到，其敏感性为 51%至 53%，特异性为 87%至 93%，阳性预测值（PPV）为 91%至 95%，阴性预测值为 42%，准确性为 63%，每位读者的准确性为 57%，当仅考虑 2 位读者的一致性（即匹配）结果时，准确性为 57%。与阳性肠内对比剂相比，阴性肠内对比剂的 CT 扫描在一致性结果方面的敏感性显著更高（58% vs 30%，P=0.01）。特异性（100% vs 95%，P=0.5）、PPV（100% vs 93%，P=0.49）、阴性预测值（39% vs 39%，P=0.99）和准确性（67% vs 51%，P=0.10）在一致性结果方面，阴性与阳性肠内对比剂之间无显著差异。读者间在胃肠道 NEN 的定位方面无显著差异。
结论
常规 MDCT 联合阳性或阴性肠内对比剂，在疑似胃肠道 NEN 的患者中，其检测至少 1 个 GI 肿瘤的敏感性超过 90%，准确性超过 50%。与阳性肠内对比剂相比，使用阴性肠内对比剂可提高胃肠道 NEN 的敏感性。此外，使用阳性或阴性肠内对比剂定位肠肿瘤具有很高的准确性，这可能指导手术。放射科医生应高度认识到，仔细评估此类扫描可能会导致比以前报道的更高的原发性肠 NEN 检出率。
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