CTを用いた犬胸骨リンパ節の評価法とその診断意義についての臨床的検討
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(2) CT * Ú34/ ¿< ¾sl© °a{¼. 2019 `. ]ÐTVTVÒÉIFV ^Ü ÌU .
(3) CT * Ú34/ ¿< ¾sl© °a{¼. ^Ü ÌU .
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(5) 5 [o 48 ÑÞO´ 49. £o 56 ÃÇ 59 q 60 .
(6) Á6¹ AUC. Area under the curve. CI. Confidence interval. COX. Cyclooxygenase. CT. Computed tomography. FNA. Fine needle aspiration. FOV. Field of view. HU. Hounsfield unit. MPR. Multi planar reconstruction. MST. Median survival time. NPV. Negative predictive value. PPV. Positive predictive value. ROC. Receiver operating characteristic. ROI. Region of interest. SD. Standard deviation. TCC. Transitional cell carcinoma. WL. Window level. WW. Window width. .
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(38) ßStLN ~E !ßSt2 ÛZ' StLN b |ÝStLNÝSt2Þ*B St2 Û ßsA St2 ØW824L's×kB St2 ÎÝO 1-1ÞßStLN b$ St2 Û ßA1wf 2/5 & 3 5%@y$'WÃZ*3'!ßsA W ²^ /? RJÝ54Þ*QsA$&Î0^Ý bÝÎb|0.5Þß;0^Ý0.5ÞbÝÎb|0.8Þß$ 0^ÝbÝÎb| ß0.8Þ<ÙCT ? /5 & 3. 5%5 . 3 !ßs. AÉ£ 3 y/7 2 StLN {B ß 4 mm2 /7 s ×5 ßÉ£'2A )Ð " *W Ý10Þ. 2-3 ¢¶ºx z_ StLN 7Ò?*!'!ß65 2 /7 34/. ¸!%(Ô ß""T 34/*ºxStLN ßSt2 ß$ StLNÝSt2 4Î Ñ*( (:K[<x$&¿<ß}W 7mÝR2Þ*B¢¶2 JMP 10.0ÝSAS Institute Inc., Cary, North CarolinaÞ*ß_%(¢y P < 0.05 *sl. 3 ¢y 3-1 5 ¹zsÐ)Í CT {z*Xu 1,575 5 ß152 5 ¡ :(Q 6.
(39) *`Ü$ 4Î )P? ( ( 9.4 {Ý1.315.3 {Þß10.1 kgÝ2.0 36.3 kgÞ&ßi= ;¿ uÎRÔ 38 5ßÎRÔ 31 5ßu=7Ó 60 5ß =7Ó 23 5( ( 5 ´ 1-1 È&¾s(ß( j " StLN ieÖ*C " . 3-2 CT ' StLN h 152 5 ß1 "
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(42) ßÄe? S
(43) 34/ N6wĸ!%( ß22 5 34/Ý14.5%Þ (N6&ß 20 5 34/ Á¤Í CT ? )`Í$&"Û ß 20 5) 15 5 4Î 15 kg /7 )O TO Äeg 34/ ("N6P`(. 3-3 StLN ~E StLN b 4Îz Ñ*ÝR2 = 0.74ßP < 0.001ÞO 1-2AÞA} St2 Û"4Îz Ñ*ÝR2 = 0.87ßP < 0.001ÞO 1-2BÞß4v$ % StLN Q?*!'!ß( ( 5 StLNÝSt2 * B ¢yß!'| )P? 0.45Ý95% CIß0.3170.596Þ ßK[_ y = 0.007x + 0.466Ýx, 4Î [kg]ÞyßStLNÝSt2ÞÝO 1-2CÞ 95% CI *̪5 ß7Ò*7K5 (" StLN z_'" 7.
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(75) Äe5g8Ð 300 mg !5/kg W %ß9(% LT Ñ7'" ª%(' 4 { $'~E Milovancev et al.Ý49Þ Ã ßt ºx St2 $'~E % Æ' ßAZÆ ßCT º §$ ºx. *|¿ºx a¶&ß °a*Ô'Xi". ªf7{¼(' . 5 [o @_ ' StLN CT $&Vn{Bߺx' H« %Ñ StLNÝSt2 $&ß4Î6T6W?*!'. 95% CI 7Ò? 0.596 ß ? l©'" ! CT {zApV{z*Xu'$'{À a¶ '
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(94) 2 CT /205,*Ú34/ÆZ'¾sc ºx. 1 ¤» ki¯¨j Z×P$ ËÓ34/ Æ s*z¿< ' ßÆ3~t Çh#:g: !a×'{z'¯Í j*¿<'7ßStLN ¯T*{Bß ki¯, j*Í= ' ζ'34/ R*¿<'Ô FNA $' ¬V{z > Øi Ût'ª%(' Ý4ß42ÞßStLN FNA ºCVw Ä7ßXu MÔNI ' ßM StLN ¿< 9 X ¥{z# ÄÕ{zA¾s$(' %ßStLN X ¥#ÄÕ{z)cÎc¯TNI {BH«'!߯Tß"
(95) ¾c ¯T StLN ß Æ ¼ "·Ê('H«i HW )ßCT ki¯¨j '34/ {BßX ¥#Ä Õ{z$&"9('RJ ¼mTM'Ý56ß58ß60Þ(6ß Ê= RJ CT @_ z_34/*¿<'7"s1-3.+ '*'Ý8ß10ß38Þ %ßCT 34/Æ s Í=s@' *¹zq ·d% 1 ß@_ 'z_ StLN CT 7 h*¹ ßSt2 |* '4Î6Tz_ 7Ò?*½WÝ27Þ % t ßCT {z FNA *ApXu5*KÚiBßÆ ¸!% (NI¸!%(NI StLN h*|¿7ß h* ÆZ'¾sc*!'*ºx*². 17.
(96) 2 wr$ t 2-1 5 ¡ :(¦< ]ÐTVAÒ 2013 ` 8 r % 2016 ` 3 r Ð CT {z StLN Z' FNA *ApXu *iBßKÚºx 5 CT {zXuv 2 ËÐ/;È4{zß´{z߯ÍÄÕ{z$ Í X ¥ {z*? &ßGj ßStLN Z'{z?"
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(98) StLN Æ W¾s( 5ß$ StLN Z' CT A ºx B<Xu 5 ÒO
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(100) g A ß450 mg !5/kg Äe5Ý%/5 300ß6$/ßw&ßv tÞ* 2025 Ð Ö¬;g8 3060 gkA'$&>_ . 2-3. StLN Z' CT Aºx. StLN ºx -È CT {z*Xu5 A*"² 1 A6 v(ß 5 Í CT A*¥Óv(ÝWLß10ÞWWß300Þ1 wfßA. 5#. ÝOsiriX version 4.1.2ßOsiriX PixmeoßGenevaß. SwitzerlandÞ* 3D MPR *)f>_A %ßStLN ß ^ßÄe5g8?g ' CT ?$ N6i*·Ë StLN ¶ b*bW?ÝAbsolute-sizeÞ ßsA StLN qT'tB Î*ÎbÔß A6AÎ bZ'LtB Î
(101) ß?A} t$& StLNÝSt2 " BÝRatio-sizeÞ(% W sA²ÝO 2-1Þ ^ ? A} t$&ßÎ0^ÝbÝÎb|0.5Þ ß;0^Ý0.5ÞbÝÎb| 0.8Þß$ 0^ÝbÝÎb|ß0.8Þ<ÙCT ? StLN qT' s×ß/5 & 3 5%5 . 3 !34/Á¤Í*I.
(102) 34/;Í ROI *½Wß[N?·ËStLN N6i ß /' W©VN6"
(103) (N6 2 /,54<ÙÝN6/,54ß StLN XÇ-4 :6 Hc*s'" Þ(N6/,54ßStLN XÇ m Hc*s'" ß34/Á¤Hc P6*s'" ß' 3 4/XÇ;Í<Hc P6*s'" CT ?$ N6i ß( (Äe5g8?g8g( (¿<. 2-4. StLN Z' ¬V{z 19.
(104) StLN Æ s ßCT {zAvÄÕ'"
(105) CT ' FNA *Xuß_%(4& % ¬V¾s ¬<_ Ýg #25u²ÝMerck KGaA, Darmstadt, GermanyÞ*²ß¾sB< ¬ f>('" *¾sFgB <_~t ß5# 5 ' StLN hÑ'cR*%(W JÏF $¿<(. 2-5 ¢¶ºx StLN ÆÑ8'H«i 'Rm*iB'!ßÆÓi¦ÆÓi ¦Ð/':Rкx*²ÝG©Rmß) i=ßStLN ^ ßN6iÝÄe?$ ÄegÞ ß$ ¯~º sZ Fisher's z {W*²ÞÉ£Rmß ) `Üß4ÎßSt2 Ûß StLN ÝAbsolute-size $ Ratio-sizeÞ$ CT ?ÝÄe5g8?$ g8gÞZ ß(% Rm 2% ^ßShapiro-Wilk {W ¢y %z½<Y !ß 4/20 3{W' Mann-Whitney U {W*²£ßiB (Rm ' LT eÖ*Ò='!ß.#*SR Ð".+K[<x*²SRкx¡ ùnRm ß:Rкx ¢y P ? < 0.10 " ß SÎ/¥i*ªfÇh SÎ/¥i ß <l`T7m10 2 Rm*SÎ/¥i&/s StLN Z'ƾs ! qÆ . ? ßROC q¥*}W. Absolute-size Ratio-size ¾sc |¿ºx ßDeLong {W$ AUC *|¿'$&² ¢¶2 ¢¶ºx. ' EZR *Ý29ÞßP < 0.05 *¢¶. Vsl. 20.
(106) 3 ¢y 3-1 5 2013 ` 8 r % 2016 ` 3 r Ð CT {z StLN Z' FNA *ApXu 71 5 ß57 5*t¡ :(& 14 5 ßFNA $'4 34 (B<W¾s±% !ÒO¡ :(5 ;¿ /' È&'Ý$ . -. 4Ý11 5Þ ß2!25& 3. 5Ý6 5Þ ßÕÝ5 5Þß
(107) 5& 4 35Ý4 5Þßt Ý3 5Þ ß 5-5 35Ý2 5Þ ß$ . . 5Ý2 5Þ ß&. 5 54!"5. Ý2 5Þß/Ý2 5Þß55Ý2 5Þß 5&Ý2 5Þ ß 24 # .3Ý2 5Þß& 14 5 ( (' `Ü$ 4Î )P? ( ( 10.3 {Ý2.316.5 {Þß13.8 kgÝ2.546.0 kgÞ&ß i= ;¿ uÎRÔ 19 5Ý33%ÞßÎRÔ 17 5Ý30%Þ ßu=7Ó 10 5Ý18%Þ ß =7Ó 11 5Ý19%Þ StLN 4& ÄÕ'Ý9 5Þ"
(108) CT 'Ý48 5ÞFNA $f>GjZ'V¾s StLN Æ s$&ß - 57 5*ÆÓi¦Ý21 5ÞÆÓi¦Ý36 5Þ<Ù( ( ¦ 'Gj*´ 2-1 S)`iÝ-ÈiÞR i#34/ ¯Ý9 5Þ¡¦i§¯Ý2 5Þ*Ò
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(111) Ratio-size "SRкxiB(Rm'Äe5g8? CT ? ß . ?*. 37.5 HU Ôdc 63.9%ßc 80.0%
(112) 6tß0^ StLN 22.
(113) c 95.2%ßPPV93.3%Û?* ßdc$ NPV ( ( 38.9%ß 47.6%3
(114) ß-4¾sc Û
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(116) ßc PPV ( ( 72.2%ß70.6%&ß¾s c 7o¯~º*25 ßÆÓi¦ 3 5 Ý Bi¯~ß Bi¯~ß$ B´i¯~ 1 5ÞÆÓi¦ 5 5) 2 5ÝBi¯~ß $ B´i¯~ 1 5Þ ßRatio-size . ? 7K Äe5g. 8? CT ? ? 7K%
(117) ß(% 2 Rm (" . ?*7K% Ô ßNPV 76.5%. 4 ªY t 's ßStLN Z' ¬¾ CT {z*ApXu 'ß34/Æ ¾sc*!'ºx&ß2 Î ¶· _%(6ßStLN W?$&" St2 |*t. $&z¿< 'ß ßSRкx|*Äe5 g8? CT ? ßÆ s*Í='! slRm&ß 2 Rm* ' q"c Ûƾs ''(% · ß $'п<
(118) Ç¿<"6'$&ßCT 34/Æ { B !s¾s5&&'*'
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(129) RJ(%ßt '¢y m· 34/Æ Í=s'*' 'K ¾sc ºxß""34/Æ*zÍ= Rm Ratio-size &ß(*'dc 75.0%ßc 81.0%ß$ zc 77.2%¢y _%(% Ratio-size Äe? CT ?*¡ I)ß (% (" . ?*7KÔ ßc$ PPV (" 100%. ¢y±354{z&ß¾s{z j#Æ 25.
(130) *W'!c# PPV dc$&"9*(' ß'K ¡ I)ºx ßStLN Æ ¾s{z×_s@n|&'
(131) ß t*Èdc -43Ý) (Ói ÛÞ¢y ßStLN Æ Ói' CT m· %s»' |¿Ô *lC'7Ã È&ÆÓi 34/ a"¯T')
(132) ßÆÓi¦ 'Äe? CT ? T
(133) % ¸(( %
(134) ¬ 34/;4!'c*Do'" ª%('¢y ßÆ34/ '(%
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(137) &¯~ TM' ߺ¯ ~*I ßPÐ34/ :' StLN ¯T' ßXÇf< RÏ ('! CT ? 3'' '(%(Ói StLN *ÒO'ß c$ PPV 7o'" ª%('StLN ¯T ´¯ÑÉ ' RJ(&Ý53ß67Þß% Bi"
(138) Bi¯~$" # CT ? RE'*ß'K ºx ' t
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(141) % ß ¬¾°4 ¾sc'34/ ¬¾ % Û¾s c'»)('6tÝ4ß42Þ߯ Ù$dc 63%75%
(142) 'RJ#ß¡¦¾s 6± 'RJ 'Ý21ß 25ß40Þ434 MÔÍ; ' ß{#pB$'¡¦¾s$ ß Æ¾s H«' $ß¡ :(5 |¿W mß Äe5g8 % 6Í 5 Xu( b% (' CT m·_%('cR#¾sc ºx¢y(CWeÖ*C '!ßCT kA" &*¢6E7 $&T½x4&6Ö. sU('. 5 [o CT StLN ßW?$&" St2 |*'$&z¿< ' H«Äe5g8? CT ? ¡ I)$ &ß34/Æ*×_Ûc¾s' t '(% · ßki¯¨j % ×=µ StLN Æ*¾s ' *&ß~ Çh#:g:scR*g$'" ' \H¯ StLN Æ ÛÚc¸!%(' < !ß (% ¯ ' StLN CT m· :g $eÖ*C *¹ ' ß°a¾Î¶'c)( . 27.
(143) ÑÞO´. O 2-1. Ú34/ÝStLNÞb$ 2 Ú<ÝSt2ÞÛ W ÝAß BÞÝsA StLN qT'tB Î*ÎbßÎbL 's×kB StLN Î*bÝaÞ' ÝCßDÞ ÝsA St2 ØW824L's×kB St2 Î*ÛÝbÞ' StLN ' Absolute-size ÝaÞßRatio-size (a)Ý(b)B. . 28.
(144) ´ 2-1. Ú34/Æ s$¦< 5 'Gj ;¿. ¦. ¾sÝ5mÞ. ÆÓi¦Ýn = 21Þ ×kijÝn = 5Þ ®[¯Ý2Þß«´¯Ý1Þß*°¯Ý1Þßei¥Ý1Þ kijÝn = 16Þ. «°´§¯Ý2ÞßÛ® ¬¯Ý2Þ ß©ÏJ"34° Ý2ÞßÚ§¯Ý1Þߣ ¬¯Ý1Þ ß°Ý1Þ ß;O° Ý1Þß?°²7Ý1Þß7¯Ý1Þ߯O<°Ý1Þß *°°Ý1ÞßEHO34/¯Ý1Þßru دÝ1Þ. ÆÓi¦Ýn = 36Þ. S)`O34/¯Ý9Þß*°°Ý4Þß;O°Ý2Þßu< E§ ¬¯Ý2Þ߬¨²7Ý2Þߪ°§¯Ý2Þß¡ ¦§¯Ý2Þߪ°Ý2Þß@;ki02 5#Ý1ÞÚ §¯Ý1Þߥ°Ý1Þß©ÏJ"34°Ý1Þ ßki) ¯Ý1Þ ß½[[7Ý1Þߪ ¬Ý1Þߥ ¬Ý1Þß ¯O<°Ý1Þ߯;s(n§¯Ý1ÞßE°Ý1Þ. ¶. 57. . 29.
(145) ´ 2-2. &04 $ CT m· ¦Ð:RÐ|¿. Rm. ÆÓi¦. ÆÓi¦. i=Ýn) Ô. 13Ý61.9%Þ. 23Ý63.9%Þ. Ó. 8Ý38.1%Þ. 13Ý36.1%Þ. P ?. &04 . 1. ¶. 21. 36. `Ü)P?Ý{Þ. 9.2Ý2.315.4Þ. 10.9Ý6.316.5Þ. 0.06. 4Î)P?ÝkgÞ. 9.0Ý5.234.7Þ. 14.8Ý2.546.0Þ. 0.45. Absolute-size )P?ÝcmÞ. 0.8Ý0.41.6Þ. 1.2Ý0.62.2Þ. 0.003. Ratio-size )P?. 0.8Ý0.51.3Þ. 1.2Ý0.82.9Þ. < 0.001. ^Ýn) Î0^. 5Ý23.8%Þ. 1Ý2.8%Þ. ;0^. 15Ý71.4%Þ. 21Ý58.3%Þ. 0^. 1Ý4.8%Þ. 14Ý38.9%Þ. CT?ÝHUÞÄe?)P?. 28.7Ý16.151.7Þ 41.1Ý21.692.0Þ. < 0.001. Äeg)P?. 77.8Ý47.794.8Þ 76.1Ý51.1144.4Þ. 0.51. N6iÝnÞ Äe? N6. 15Ý71.4%Þ. 32Ý88.9%Þ. 0.14. (N6. 6Ý28.6%Þ. 4Ý11.1%Þ. CTm·. ¶. 21. 36. Äeg N6. 5Ý55.6%Þ. 6Ý46.2%Þ. (N6. 4Ý44.4%Þ. 7Ý53.8%Þ. ¶. 9. ¯~ºÝnÞ. 0.002. 1. 13. 3Ý14.3%Þ. 30. 5Ý13.9%Þ. 1.
(146) ´ 2-3.. ".+K[<x$'Ú34/ ÆÑÉLT {. |.
(147) . ?. # !" $ . .
(148) . . Äe5g8? ?ÝÞ. . . . LT. . 31.
(149) O 2-2. Ú34/ÆZ' ROC q¥* Absolute-sizeÝ¥Þ Ratio-sizeÝX¥Þ ¾sc |¿Ratio-size $ Absolute-size $' ROC q¥ AUC ( ( 0.86Ý95% CIß0.760.97Þß0.74Ý95% CIß0.600.87Þ &ß2 WÐ slZ ¸!%(ÝP = 0.04Þ . 32.
(150) ´ 2-4. CT m·*Ú34/Æ ¾sc. . dc. c. CT m· Absolute-size Ratio-size Äe? CT ? ^. ?. PPV. NPV. zc AUC. Ý%Þ. Ý%Þ. Ý%Þ. Ý%Þ. Ý%Þ. 1.1 cm. 69.4. 71.4. 80.6. 57.7. 70.2. 0.74. 1.0. 75.0. 81.0. 87.1. 65.4. 77.2. 0.86. 37.5 HU. 63.9. 80.0. 85.2. 55.2. 69.6. 0.77. 3. 38.9. 95.2. 93.3. 47.6. 59.6. 0.73. . Î0^ß;0^ß$ 0^34/ ( ( 1ß2ß3 ÙbRm Rh. . 33.
(151) ´ 2-5.. Ratio-size Äe5g8? CT ?*¡ I)Ô Ú34/Æ. Z'¾sc. dc. c. PPV. NPV. zc. Ý%Þ. Ý%Þ. Ý%Þ. Ý%Þ. Ý%Þ. 18. 50.0. 100.0. 100.0. 53.8. 68.4. 39. 77.8. 61.9. 63.6. 76.5. 69.2. 31. 75.0. 72.2. 70.6. 76.5. 73.5. ÝRatio-sizeßÄe? CT ?Þ n Ý+, +Þ Ý+, −ÞorÝ−, +Þ ¯~º5*I Ý+, −ÞorÝ−, +Þ ¯~º5*I
(152) +ß ?*Ä'34/Þ−ß . 34. ?*Ä34/.
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(154)
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