Using receiver operating characteristic curves to evaluate the diagnostic value of the combination of multislice spiral CT and alpha-fetoprotein levels for small hepatocellular carcinoma in cirrhotic patients
Using receiver operating characteristic curves to evaluate the diagnostic value of the combination of multislice spiral CT and alpha-fetoprotein levels for small hepatocellular carcinoma in cirrhotic patients
复制标题
利用受试者工作特征曲线评价多层螺旋CT与甲胎蛋白水平联合对肝硬化小肝癌的诊断价值
DOI：
10.1016/s1499-3872(17)60018-3
复制
发表时间：
2017-06-01
影响因子：
3.3
通讯作者：
Jiang, Hui-Jie
中科院分区：
文献类型：
--
作者：
Jia, Guang-Sheng;Feng, Guang-Long;Jiang, Hui-Jie
背景技术背景：多层螺旋CT（MSCT）多期增强扫描的多种组合使肝硬化背景下的小肝癌（sHCC）的诊断成为可能。为探讨MSCT增强扫描与甲胎蛋白（AFP）联合应用是否能提高sHCC的诊断效率，选择35例sHCC患者和52例无HCC影像学表现的肝硬化患者作为对照组。诊断由三位放射科医师采用5分制评分标准，以术后病理结果为金标准。采用受试者工作特征曲线（ROC）分析评价3种MSCT组合模式的诊断价值在肝硬化背景下sHCC（动脉期+门静脉期、动脉期+延迟期、动脉期+门静脉期+延迟期）和AFP水平。动脉期+门静脉期+延迟期组合的ROC曲线下面积（AUC）、敏感性和特异性分别为0.93、93%和82%。动脉相+门静脉相+延迟相组合的平均AUC显著大于动脉相+门静脉相（AUC=0.84，P=0.01）和动脉相+延迟相（AUC=0.85，P=0.03）。动脉相+门静脉相的AUC（0.84）小于动脉相+延迟相的AUC（0.85），但差异无统计学意义（P=0.15）。MSCT增强扫描与AFP联合应用后，其AUC、敏感性和特异性分别为0.95、94%和83%，大大提高了sHCC的诊断效率。结论：AFP与MSCT三期增强扫描联合应用可提高肝硬化背景下sHCC的诊断效率。ROC曲线分析的应用为肝癌的诊断提供了一种新的方法和参考。
BACKGROUND: The various combination of multiphase enhancement multislice spiral CT (MSCT) makes the diagnosis of a small hepatocellular carcinoma (sHCC) on the background of liver cirrhosis possible. This study was to explore whether the combination of MSCT enhancement scan and alpha-fetoprotein (AFP) level could increase the diagnostic efficiency for sHCC.METHODS: This study included 35 sHCC patients and 52 cirrhotic patients without image evidence of HCC as a control group. The diagnoses were made by three radiologists employing a 5-point rating scale, with postoperative pathologic results as the gold standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of the three MSCT combination modes (arterial phase+portal-venous phase, arterial phase+delayed phase, arterial phase+portal-venous phase+delayed phase) and AFP levels for sHCC on the background of liver cirrhosis.RESULTS: The area under ROC curve (AUC), sensitivity, and specificity of the combination of arterial phase+portal-venous phase+delayed phase were 0.93, 93%, and 82%, respectively. The average AUC of the arterial phase+portalvenous phase+delayed phase combination was significantly greater than that of the arterial phase+portal-venous phase (AUC=0.84, P=0.01) and arterial phase+delayed phase (AUC=0.85, P=0.03). Arterial phase+portal-venous phase had a smaller AUC (0.84) than arterial phase+delayed phase (0.85), but the difference was insignificant (P=0.15). After combining MSCT enhancement scan with AFP, the AUC, sensitivity, and specificity were 0.95, 94%, and 83%, respectively, indicating a greatly increased diagnostic efficiency for sHCC.CONCLUSIONS: The combination of AFP and 3 phases MSCT enhancement scan could increase the diagnostic efficiency for sHCC on the background of liver cirrhosis. The application of ROC curve analysis has provided a new method and reference in HCC diagnosis.