A Preliminary Study on the Prediction of the Perforation Site of Digestive Tract Based on Multi-Slice Spiral CT (MSCT) Imaging Features Combined with Clinical Nomographic Model

目的：探讨基于MSCT临床联合影像特征列线图模型预测消化道穿孔部位。方法：回顾性分析267例经手术证实消化道穿孔患者临床及MSCT资料。筛选预测消化道穿孔部位的影响因素，构建Nomogram模型，并评估模型的预测能力。结果：经手术证实上消化道穿孔182例，其中异物穿孔1例，溃疡穿孔181例；下消化道穿孔85例，其中异物(鱼刺、枣核等)穿孔22例，疝嵌顿致穿孔8例。观察腹腔内/腹膜外游离气体、胃肠壁局限性增厚，胃肠壁连续性中断、腹膜炎、异物征、肠梗阻。筛选出膈下、胃十二指肠周围游离气体、异物征，肠梗阻4个独立影响因素，同时运用列线图构建评分模型。列线图模型的C-index = 0.830，Bootstrap自抽样法内部验证校正C-index = 0.661。结论：基于膈下、胃十二指肠周围游离气体、异物征、肠梗阻构建的列线图模型对预测消化道穿孔部位具有一定的价值。Objective: To explore the prediction of the perforation site of digestive tract based on multi-slice spiral CT (MSCT) imaging features combined with clinical nomographic model. Methods: We make retrospective analysis of the clinical data and MSCT images of 267 patients with surgically proven perforation of digestive tract. Screen the influencing factors for predicting the location of perforation of digestive tract, build a nomographic model and evaluate the predictive power of the model. Results: The perforation of upper digestive tract (stomach and duodenum) has been confirmed by surgery in 182 cases, including one case of foreign body perforation and 181 cases of ulcer perforation. What’s more, the author has offered 85 cases of lower digestive tract perforation (jejunum, ileum, cecum, colon and rectum), 22 cases of foreign body perforation (fish bones, jujube nucleus, etc.) and 8 cases of perforation caused by hernia incarceration. Additionally, the author has also observed the intraperitoneal and extraperitoneal free gas, therefore, the author has localized thickening of gastrointestinal wall, interruption of continuity of gastrointestinal wall, peritonitis, foreign body sign as well as signs of intestinal obstruction. As a result, four independent influential factors have been screened out: subdiaphragmatic free gas in the subphrenic space, free gas around stomach and duodenum, foreign body crossing the intestine and associated with bowel obstruction. At the same time, a scoring model has been constructed by nomographic model. That is to say, a C-index of nomographic model = 0.830, Bootstrap self-sampling internal verification and correction C-index = 0.661. Conclusion: The nomographic model based on subdiaphragmatic free gas in the subphrenic space, free gas around stomach and duodenum, foreign body crossing the intestine and associated with bowel obstruction has certain value in predicting the location of the perforation site of digestive tract.