目的:探讨CT尿路造影(CTU)指标在膀胱尿路上皮癌(BUC)和膀胱内翻性乳头状瘤(IPB)定量鉴别诊断中的价值。
方法:回顾性分析103例经组织学证实的BUC或IPB患者的临床及术前CTU影像学资料。影像学资料包括6项定性指标和7项定量指标。对记录的临床资料和影像学特征进行单因素和多因素logistic回归分析,寻找BUC的独立危险因素。并构建了多指标组合预测模型,并使用列线图将预测模型可视化。采用ROC曲线分析计算并比较独立危险因素和列线图的预测效果。
结果:结光滑度,最大纵向直径,肿瘤-壁界面和动脉强化率是区分BUC和IPB的独立危险因素。联合模型的AUC为0.934(敏感性=0.808,特异性=0.920,准确性=0.835),诊断效率高于接头平滑度(AUC=0.667,灵敏度=0.654,特异度=0.680,准确度=0.660),最大纵向直径(AUC=0.757,灵敏度=0.833,特异性=0.604,准确性=0.786),肿瘤-壁界面(AUC=0.888,敏感性=0.755,特异性=0.808,准确性=0.816)和动脉强化率(AUC=0.786,敏感性=0.936,特异性=0.640,准确性=0.864)。
结论:上述基于CTU的定性和定量指标及其组合可能有助于BUC和IPB的鉴别诊断。从而更好地协助临床决策。
结论:1.膀胱尿路上皮癌(BUC)和膀胱内翻性乳头状瘤(IPB)表现出相似的临床症状和影像学表现。2.尚未记录CT尿路造影(CTU)在区分BUC和IPB方面的诊断价值。3.BUC和IPB的病变大小不同,生长模式和血液供应。4.通过将多个独立的风险因素集成到预测模型中来优化诊断效率。
OBJECTIVE: To investigate the value of CT urography (CTU) indicators in the quantitative differential diagnosis of bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB).
METHODS: The clinical and preoperative CTU imaging data of continuous 103 patients with histologically confirmed BUC or IPB were retrospectively analyzed. The imaging data included 6 qualitative indicators and 7 quantitative measures. The recorded clinical information and imaging features were subjected to univariate and multivariate logistic regression analysis to find independent risk factors for BUC, and a combined multi-indicator prediction model was constructed, and the prediction model was visualized using nomogram. ROC curve analysis was used to calculate and compare the predictive efficacy of independent risk factors and nomogram.
RESULTS: Junction smoothness, maximum longitudinal diameter, tumor-wall interface and arterial reinforcement rate were independent risk factors for distinguishing BUC from IPB. The AUC of the combined model was 0.934 (sensitivity = 0.808, specificity = 0.920, accuracy = 0.835), and its diagnostic efficiency was higher than that of junction smoothness (AUC=0.667, sensitivity = 0.654, specificity = 0.680, accuracy = 0.660), maximum longitudinal diameter (AUC=0.757, sensitivity = 0.833, specificity = 0.604, accuracy = 0.786), tumor-wall interface (AUC=0.888, sensitivity = 0.755, specificity = 0.808, accuracy = 0.816) and Arterial reinforcement rate (AUC=0.786, sensitivity = 0.936, specificity = 0.640, accuracy = 0.864).
CONCLUSIONS: Above qualitative and quantitative indicators based on CTU and the combination of them may be helpful to the differential diagnosis of BUC and IPB, thus better assisting in clinical decision-making.
CONCLUSIONS: 1. Bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB) exhibit similar clinical symptoms and imaging presentations. 2. The diagnostic value of CT urography (CTU) in distinguishing between BUC and IPB has not been documented. 3. BUC and IPB differ in lesion size, growth pattern and blood supply. 4. The diagnostic efficiency is optimized by integrating multiple independent risk factors into the prediction model.