摘要
目的探讨能谱CT定量参数与胃腺癌程序性死亡配体-1(PD-L1)不同表达状态的相关性,为胃腺癌患者免疫治疗的选择提供更多影像学参考。资料与方法回顾性收集兰州大学第二医院2021年1月—2023年9月行初诊能谱CT扫描且经活检病理证实为胃腺癌并在治疗前接受PD-L1检测的45例患者。根据PD-L1表达状态,将患者分为联合阳性评分较高表达组(≥5分)和较低表达组(<5分)。在动、静脉期单能量图像上,获取病灶CT值(CT_(40 keV)、CT_(70 keV))、有效原子序数、碘浓度,计算标准化碘浓度与能谱曲线斜率;比较各能谱CT参数的组间差异。绘制受试者工作特征曲线,计算曲线下面积,评估各单一参数及联合参数区分PD-L1表达的效能。结果动脉期较高表达组的病灶CT_(40 keV)、CT_(70 keV)、碘浓度、标准化碘浓度、有效原子序数、能谱曲线斜率均明显高于较低表达组(t/Z=-3.115~-2.725,P均<0.05),静脉期各参数差异无统计学意义(P均>0.05)。增强动脉期标准化碘浓度区分PD-L1表达状态的曲线下面积为0.755(95%CI 0.612~0.898),敏感度为81.8%,特异度为65.2%,与其他动脉期单一能谱CT参数间差异无统计学意义(P均>0.05),与联合参数的诊断效能相近[曲线下面积0.755(95%CI 0.613~0.897),敏感度为90.9%,特异度为52.2%]。结论动脉期能谱CT定量参数可以在一定程度上预测胃腺癌PD-L1表达,为胃腺癌患者的筛查与免疫治疗评估提供参考。
Purpose To explore the correlation between spectral CT-derived quantitative parameters and different programmed deathligand 1(PD-L1)expression status in gastric adenocarcinoma,in order to provide additional imaging-based references for immunotherapy regimen selection in patients with this disease.Materials and Methods A total of 45 patients with gastric adenocarcinoma,pathologically confirmed by biopsy,who underwent PD-L1 testing prior to treatment were retrospectively enrolled from Lanzhou University Second Hospital between January 2021 and September 2023.All patients underwent baseline spectral CT scans.Based on PD-L1 expression status,patients were categorized into the higher combined positive score(CPS)group(CPS≥5)and the lower CPS group(CPS<5).From the single-energy images of arterial and venous phases,the CT values(CT_(40 keV),CT_(70 keV)),effective atomic number,and iodine concentration of the lesions were measured.The standardized iodine concentration and slope of the spectral curve were calculated.Differences in spectral CT parameters between the two groups were compared.Receiver operating characteristic curves were plotted for parameters with statistically significant differences,and the area under the curve was calculated to evaluate the efficacy of each single parameter and combined parameters in distinguishing PD-L1 expression status.Results In the arterial phase,the CT_(40 keV),CT_(70 keV),iodine concentration,standardized iodine concentration,effective atomic number,and slope of the spectral curve of lesions in the higher expression group were all significantly higher than those of lesions in the lower expression group(t/Z=-3.115 to-2.725,all P<0.05),whereas no significant differences were observed in all parameters in the venous phase(all P>0.05).For the standardized iodine concentration in the enhanced arterial phase,the area under the curve for distinguishing PD-L1 expression status was 0.755(95%CI 0.612 to 0.898),with a sensitivity of 81.8%and a specificity of 65.2%.No significant differences were found between it and other single spectral CT parameters in the arterial phase(all P>0.05),and its diagnostic efficacy was similar to that of the combined parameters[the area under the curve was 0.755(95%CI 0.613 to 0.897),sensitivity was 90.9%,specificity was 52.2%].Conclusion Quantitative parameters of spectral CT in the arterial phase can predict the PD-L1 expression of gastric adenocarcinoma,which may provide a reference for the screening and immunotherapy evaluation of patients with gastric adenocarcinoma.
作者
陈倩倩
徐敏
任铁柱
彭月
马龙
张文娟
CHEN Qianqian;XU Min;REN Tiezhu;PENG Yue;MA Long;ZHANG Wenjuan(Department of Radiology,Lanzhou University Second Hospital,Lanzhou 730030,China;The Second Clinical Medical School,Lanzhou University,Lanzhou 730030,China;Key Laboratory of Medical Imaging of Gansu Province,Lanzhou 730030,China;Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence,Lanzhou 730030,China)
出处
《中国医学影像学杂志》
北大核心
2025年第11期1215-1220,共6页
Chinese Journal of Medical Imaging
基金
甘肃省省级人才项目(GZTZ2024-4)
甘肃省联合科研基金重大项目(24JRRA921)
兰州市青年科技人才创新项目(2023-2-44)。
