胃癌壁外血管侵犯MDCT表现对淋巴结转移的诊断价值

朱政锜; 段书峰; 龚海鹏

doi:10.15953/j.ctta.2023.005

胃癌壁外血管侵犯MDCT表现对淋巴结转移的诊断价值

江苏省南通市肿瘤医院放射科, 江苏南通226300

基金项目: 南通市卫生健康委科研课题（双能CT不同ROI选择对胃癌患者术前分期及临床预后的诊断价值研究（QN2022033））。

详细信息

作者简介:
朱政锜: 男，江苏省南通市肿瘤医院放射科住院医师，主要从事腹部肿瘤影像诊断，E-mail：747974617@qq.com

通讯作者:
段书峰: 男，江苏省南通市肿瘤医院放射科副主任医师，主要从事腹部肿瘤影像诊断，E-mail：14668241@qq.com。

中图分类号: R 814
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出版历程
- 收稿日期: 2023-01-07
- 修回日期: 2023-09-19
- 录用日期: 2023-09-21
- 网络出版日期: 2023-11-22
- 刊出日期: 2024-02-29

Diagnostic Value of CT-detected Extramural Vessel Invasion in Lymph Node Metastasis of Gastric Cancer

Department of Radiology, Nantong Cancer Hospital, Nantong 226300 China

摘要

摘要:
目的：探讨胃癌壁外血管侵犯MDCT表现对淋巴结转移的诊断价值。方法：回顾性收集2020年1月至2022年6月经手术病理证实的105例胃癌患者；所有患者CT扫描后2周内行根治性胃癌切除术与D2淋巴结清扫术；门脉期MDCT图像上采用5分量表对胃癌EMVI情况进行评估；根据病理淋巴结转移情况将患者分为淋巴结转移组与非淋巴结转移组。比较两组间临床病理特征差异，多因素Logistic回归分析胃癌淋巴结转移的影响因素，受试者操作特征（ROC）曲线用于评估ctEMVI对淋巴结转移的诊断价值，比较ctEMVI和淋巴结短径对淋巴结转移的诊断价值。结果：淋巴结转移组中，脉管侵犯占60.9％（39例），肿瘤大小（＞5 cm）占64.1％（41例），ctEMVI阳性占79.7％（51例），CT转移性淋巴结阳性占56.2％（36例）；非淋巴结转移组中，脉管侵犯，肿瘤大小（＞5 cm），ctEMVI阳性及CT转移性淋巴结阳性分别占21.9％（9例），24.4％（10例），21.9％（9例）和19.5％（8例），两组间的差异均有统计学意义；多因素logistic回归分析显示ctEMVI是淋巴结转移的独立影响因素；ROC曲线显示ctEMVI诊断淋巴结转移的AUC为0.854。ctEMVI诊断淋巴结转移的敏感性，准确性优于淋巴结短径。结论：ctEMVI是淋巴结转移的独立影响因素，ctEMVI在诊断淋巴结转移方面具有重要价值。
- CT /
- 壁外血管侵犯 /
- 胃癌 /
- 淋巴结转移
Abstract:
Objective: To investigate the diagnostic value of extramural vessel invasion (EMVI) in multidetector row computed tomography (MDCT) of lymph node metastasis of gastric cancer. Methods: A total of 105 patients with pathologically confirmed gastric cancer treated at our hospital between January 2020 and June 2022 were retrospectively collected. All patients underwent radical gastrectomy and D2 lymph node dissection within 2 weeks after the CT scan. The EMVI status of gastric cancer was evaluated on portal-phase MDCT images using a 5-point scale. According to the pathological status of lymph node metastasis, the patients were divided into lymph node and non-lymph node metastasis groups, and their clinicopathologic features were compared. We then performed a multivariate logistic regression analysis of lymph node metastasis in gastric cancer. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of CT-detected EMVI (ctEMVI) in lymph node metastasis, and the diagnostic values of ctEMVI and lymph node short diameter in lymph node metastasis were compared. Results: In the lymph node metastasis group, lymphovascular invasion, tumor size (>5 cm), ctEMVI positivity, and CT metastatic lymph node positivity accounted for 60.9% (n=39), 64.1% (n=41), 79.7% (n=51), and 56.2% (n=36) of cases, respectively. In the non-metastatic group, lymphovascular invasion, tumor size (>5 cm), ctEMVI positivity, and CT metastatic lymph node positivity accounted for 21.9% (n=9), 24.4% (n=10), 21.9% (n=9), and 19.5% (n=8), respectively. The intergroup difference was statistically significant. The multivariate logistic regression analysis showed that ctEMVI was an independent factor of lymph node metastasis. The ROC curve showed that the area under the curve of ctEMVI for diagnosing lymph node metastasis was 0.854. The sensitivity and accuracy of ctEMVI were superior to those of lymph node short diameter in the diagnosis of lymph node metastasis. Conclusion: This study found that ctEMVI was an independent factor and of great value in the diagnosis of lymph node metastasis.
- CT /
- extramural vessel invasion /
- gastric cancer /
- lymph node metastasis

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图 1 ctEMVI阳性病例

（a）MDCT横断位图像所示胃窦部肿块呈结节状延伸至胃周血管腔，受累血管轻度扩张，内见充盈缺损，ctEMVI评分3分（白箭）。腹主动脉旁见多枚短径小于8 mm的小淋巴结，术后病理示胃癌伴淋巴结转移。（b）MDCT横断位图像所示胃小弯侧肿块呈多发结节状延伸至胃周血管腔，受累血管明显扩张，形态不规则，内见充盈缺损，ctEMVI评分4分（白箭）。胃小弯侧见多枚短径小于8 mm的小淋巴结，术后病理示胃癌伴淋巴结转移。

Figure 1. Images of ctEMVI-positive case

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图 2 ctEMVI诊断胃癌淋巴结转移的ROC曲线

Figure 2. ROC curve of lymph node metastasis in gastric cancer diagnosed by ctEMVI

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表 1 淋巴结转移组与非淋巴结转移组临床病理特征比较

Table 1 Clinicopathological features of lymph node versus non-lymph node metastasis groups

指标		组别		统计检验
指标		淋巴结转移组（n=64）（％）	非淋巴结转移组（n=41）（％）	$t/\chi^2 $	P
年龄/岁		63.3±10.40	62.1±10.65	0.605	0.546
性别	男	44（68.7）	28（68.3）	0.002	0.961
性别	女	20（31.3）	13（31.7）	0.002	0.961
肿瘤位置	胃底	10（15.6）	2（4.8）	4.786	0.091
	胃体	21（32.8）	13（31.7）
	胃窦	33（51.6）	26（63.5）
分化程度	低分化	34（53.1）	14（34.2）	3.695	0.158
	中分化	26（40.6）	24（58.5）
	高分化	4（6.3）	3（7.3）
脉管侵犯		39（60.9）	9（21.9）	15.306	＜0.001
肿瘤大小/cm	＜5	23（35.9）	31（75.6）	15.746	＜0.001
肿瘤大小/cm	＞5	41（64.1）	10（24.4）	15.746	＜0.001
ctEMVI	阴性	13（20.3）	32（78.1）	34.016	＜0.001
ctEMVI	阳性	51（79.7）	9（21.9）	34.016	＜0.001
CT转移性淋巴结	阴性	28（43.8）	33（80.5）	13.855	＜0.001
CT转移性淋巴结	阳性	36（56.2）	8（19.5）	13.855	＜0.001

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表 2 logistic回归分析胃癌淋巴结转移的影响因素

Table 2 Logistic regression analysis of factors affecting lymph node metastasis in gastric cancer

指标	B	WaldX²	OR	95％CI	P
脉管侵犯	0.817	2.135	2.26	（0.75，6.76）	0.144
肿瘤大小	0.912	2.713	2.49	（0.84，7.36）	0.100
ctEMVI	1.916	12.207	6.79	（2.31，19.89）	＜0.001
CT转移性淋巴结	1.087	3.684	2.97	（0.97，8.99）	0.055

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表 3 ctEMVI与淋巴结短径对胃癌淋巴结转移的诊断价值比较

Table 3 Diagnostic value of ctEMVI and lymph node short diameter on lymph node metastasis of gastric cancer

指标	敏感性/％	特异性/％	阳性预测值/％	阴性预测值/％	准确性/％
ctEMVI	79.7（51/64）	78.1（32/41）	85.0（51/60）	71.1（32/45）	79.1（83/105）
淋巴结短径	56.2（36/64）	80.5（33/41）	81.8（36/44）	54.1（33/61）	65.7（69/105）
P	0.004	0.785	0.665	0.785	0.031

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