摘要
目的:比较双能量CT(dual energy CT,DECT)与多层螺旋CT(multi-slice spiral CT,MSCT)在评估胃癌分化程度中的价值。方法:前瞻性选取2018年9月—2019年10月盐城市第一人民医院胃镜提示胃癌、术前行CT平扫及双期增强扫描患者115例(随机采用MSCT增强模式55例和DECT增强模式60例),以手术后病理学检查结果为金标准分为低分化组和中高分化组。采用两独立样本t检验方法比较MSCT模式下的平扫CT值、动/静脉期CT值及动/静脉期CT增加值在两组胃癌中的差异;比较双能量CT增强模式下动/静脉期标准化碘浓度(normalized iodine concentration in arterial/venous phase,NICa/NICv)、动/静脉期能谱曲线40~70 keV区间的斜率(λa/λv)在两组中的差异;同时运用受试者工作特征(receiver operating characteristic,ROC)曲线评估各参数诊断效能。结果:MSCT模式下低分化组与中高分化组静脉期CT值及静脉期CT增加值分别为97.81±8.94、92.00±8.00和61.88±7.50、56.52±6.86;DECT模式下低分化组与中高分化组NICa、NICv和能谱曲线斜率分别为(21.57±1.98)%、(20.07±1.49)%、(58.75±2.91)%、(54.84±3.55)%和-(3.20±0.25)、-(2.98±0.14)、-(3.71±0.30)、-(3.39±0.13),差异均有统计学意义(P<0.05);上述参数鉴别胃癌分化程度的曲线下面积(area under curve,AUC)分别为0.682、0.696、0.722、0.804、0.764、0.828;联合NICv与静脉期能谱曲线,AUC为0.917,选择合适阈值时灵敏度为0.862,特异度为0.871。结论:双能量CT NICa、NICv及能谱曲线能为术前评估胃癌分化程度提供新的指标,且优于传统的MSCT。
Objective:To compare the value of dual-energy CT(DECT)and multi-slice spiral CT(MSCT)in evaluation on histodifferentiation of gastric cancer.Methods:From Sep.2018 to Oct.2019,115 cases of gastric cancer were selected in Yancheng First People’s Hospital,who were diagnosed with gastric cancer by gastroscopy and underwent CT enhanced scanning before surgery,including MSCT enhancement 55 cases and DECT enhancement 60 cases randomly).The pathological results after operation were taken as the gold standard and these cases can be divided into poorly differentiated and intermediately/highly differentiated group respectively.Two independent sample t test methods were used to compare the difference of plain CT value,arterial CT value,venous CT value,arterial CT value added and venous CT value added between the two groups of gastric cancer under the MSCT mode.The differences of normalized iodine concentration and the slope(λa/λv)of the energy spectrum curve in the 40~70 keV interval in arterial and venous phase were compared between the two groups under the DECT enhancement mode.Meanwhile,receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance of each parameter.Results:The venous CT value and venous CT value added were 97.81±8.94,92.00±8.00,61.88±7.50,56.52±6.86 in poorly differentiated and intermediately/highly differentiated groups.The normalized iodine concentration and the slope of energy spectrum curve were(21.57±1.98)%,(20.07±1.49)%,(58.75±2.91)%,(54.84±3.55)%,and-(3.20±0.25),-(2.98±0.14),-(3.71±0.30),-(3.39±0.13)respectively in the two groups.The differences were statistically significant(P<0.05).The area under curves(AUC)with the above parameters were 0.682,0.696,0.722,0.804,0.764 and 0.828.Combined with normalized iodine concentration and energy spectrum curves in the venous phase,AUC was 0.917,and the sensitivity and specificity were 0.862 and 0.871 when the appropriate threshold was selected.Conclusion:The normalized iodine concentration and energy spectrum curve of DECT can provide a new index for preoperative evaluation of the differentiation degree of gastric cancer,which is better than the traditional MSCT.
作者
吉玉刚
卢定友
温竞
JI Yugang;LU Dingyou;WEN Jing(Department of CT room,Yancheng First People’s Hospital,Yancheng 224000,Jiangsu Province,China;College of Medical Imaging,Jiangsu Vocational College of Medicine,Yancheng 224006,Jiangsu Province,China)
出处
《肿瘤影像学》
2020年第6期588-594,共7页
Oncoradiology
关键词
双能量CT
胃癌
标准化碘浓度
能谱曲线
Dual energy CT
Gastric cancer
Normalized iodine concentration
Energy spectrum curve
