摘要目的:探讨CT增强检查血管进入征对胃癌脉管浸润的诊断价值。方法:采用回顾性病例对照研究方法。收集2021年8月至2022年11月长治医学院附属长治市人民医院收治的135例胃癌患者的临床病理资料；男112例，女23例；年龄为（64±8）岁。135例患者中，发生脉管浸润92例，无脉管浸润43例。患者术前均行CT增强检查。观察指标：（1）2位医师对血管进入征的一致性评估。（2）不同脉管浸润患者临床特征比较。（3）胃癌患者脉管浸润的影响因素分析。（4）血管进入征诊断价值评估。正态分布的计量资料以 x±s表示；偏态分布的计量资料以 M（范围）表示，组间比较采用非参数检验。计数资料以绝对数或百分比表示，组间比较采用 χ2检验或Fisher确切概率法。等级资料比较采用非参数检验。采用一致性检验（Cohen′s κ）评估观察者一致性（ κ值>0.8为一致性良好）。采用Logistic回归模型进行单因素和多因素分析。绘制受试者工作特征曲线，以曲线下面积评估参数的诊断效能。 结果:（1）2位医师对血管进入征的一致性评估。2位医师对血管进入征的评估一致性较好（ κ值=0.823），2位医师采用血管进入征检出脉管浸润的独立检出率分别为76.1%（70/92）和73.9%（68/92）。（2）不同脉管浸润患者临床特征比较。发生脉管浸润和无脉管浸润患者肿瘤分化程度、临床T分期、临床N分期、CA19-9、血管进入征比较，差异均有统计学意义（ P<0.05）。（3）胃癌患者脉管浸润的影响因素分析。多因素分析结果显示：临床T分期为T3期及T4期、临床N分期为N3期、血管进入征是影响胃癌患者脉管浸润的独立危险因素（优势比=3.255，11.242，7.203，3.426，95%可信区间为1.079~10.453，3.125~46.744，2.267~28.902，1.317~9.271， P<0.05）。（4）血管进入征诊断价值评估。以血管进入征计算受试者工作特征曲线下面积为0.660（95%可信区间为0.573~0.747），灵敏度、特异度、准确度、阴性预测值、阳性预测值分别为0.739、0.581、0.689、0.638、0.922。 结论:CT增强检查血管进入征是胃癌患者脉管浸润的独立危险因素，对胃癌脉管浸润具有良好诊断价值。

abstractsObjective:To investigate the diagnostic value of vascular-entry sign on enhanced computed tomography (CT) for lymphovascular invasion of gastric cancer.Methods:The retrospec-tive case-control study was conducted. The clinicopathological data of 135 patients with gastric cancer who were admitted to Changzhi People′s Hospital Affiliated to Changzhi Medical College from August 2021 to November 2022 were collected. There were 112 males and 23 females, aged (64±8)years. Of the 135 patients, 92 cases had lymphovascular invasion and 43 cases had no lymphovascular invasion. All the patients underwent preoperative enhanced CT examination. Observation indicators: (1) con-sistency assessment of vascular-entry sign between the 2 radiologists; (2) comparison of clinical characteristics of patients with different lymphovascular invasion; (3) analysis of influencing factors for lymphovascular invasion in gastric cancer patients; (4) evaluation of diagnostic value of vascular-entry sign. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed by the nonparametric test. Count data were represented as absolute numbers or percen-tages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Nonparametric test was used for ordinal data. Consistency test (Cohen′s κ) was used to assess observer consistency between the two radiologists, and κ >0.8 indicated a good consistency. Logistic regression model was used for univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC) was used to evaluate the diagnostic efficacy. Results:(1) Consistency assessment of vascular-entry sign between the 2 radio-logists. The consistency of vascular-entry sign evaluated by the two radiologists was good, with the κ value as 0.823. The detection rates of vascular-entry sign for lymphovascular invasion by the two radiologists were 76.1%(70/92) and 73.9%(68/92), respectively. (2) Comparison of clinical charac-teristics of patients with different lymphovascular invasion. There were significant differences in tumor differentiation, clinical T staging, clinical N staging, CA19-9 and vascular-entry sign between them ( P<0.05). (3) Analysis of influencing factors for lymphovascular invasion in gastric cancer patients. Results of multivariate analysis showed that stage T3 and T4 of Clinical T staging, stage N3 of clinical N staging and vascular-entry sign were independent risk factors influencing lymphovascular invasion in gastric cancer patients ( odds ratio=3.255, 11.242, 7.203, 3.426, 95% confidence interval as 1.079-10.453, 3.125-46.744, 2.267-28.902, 1.317-9.271, P<0.05). (4) Evaluation of diagnostic value of vascular-entry sign. The AUC of ROC for vascular-entry sign was 0.660 (95% confidence interval as 0.573-0.747). The sensitivity, specificity, accuracy, negative predictive value and positive predictive value were 0.739, 0.581, 0.689, 0.638, 0.922, respectively. Conclusion:Vascular-entry sign on enhanced CT is an independent risk factor for lymphovascular invasion of gastric cancer patients, which has good diagnostic value.