BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer(CRC).Low-keV virtual monoenergetic images(VMIs)have been shown to enhance lesion conspicuity.Th...BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer(CRC).Low-keV virtual monoenergetic images(VMIs)have been shown to enhance lesion conspicuity.This study aimed to assess the diagnostic value of dual-layer spectral computed tomography(CT)-derived VMIs,in combination with multiplanar reformation(MPR)and evaluation of peritumoral fat stranding(PFS),for improving the accuracy of T staging in CRC.AIM To assess the diagnostic performance of dual-layer spectral CT(DLSCT)VMIs,particularly at low energy levels,and their integration with personalized MPR for preoperative T staging of CRC.METHODS In this retrospective study,157 patients with pathologically confirmed CRC(mean age:63.5±12.1 years)underwent DLSCT within 1 week before surgery.VMIs ranging from 40 keV to 70 keV(at 10 keV intervals)and conventional polyenergetic images(PEIs)were reconstructed.Objective image quality parameters,including image noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR),were quantified,alongside subjective image quality scores using a 5-point Likert scale.Interobserver agreement was evaluated usingκstatistics.Taking histopathology as the reference standard,the diagnostic accuracy of T staging(T1-2 vs T3-4)was compared across PEIs and VMIs,both with and without MPR and PFS.RESULTS Low-keV VMIs(40-70 keV)demonstrated significantly higher SNR and CNR than PEIs(all P<0.001).Notably,40-keV VMIs achieved noise levels comparable to PEIs(8.17±3.63 vs 8.53±2.90;P=0.673).Subjective image quality peaked at 40-50 keV VMIs(Likert scores 4.85-4.88 vs 3.97 for PEIs;P<0.001),supported by excellent interobserver agreement(κ=0.812-0.913).The combination of 40-50 keV VMIs with MPR yielded the highest T staging accuracy(94.27%)compared to axial PEIs(70.7%),with a sensitivity and specificity of 83.87%and 96.83%,respectively(Youden index=0.81;P<0.05).While PFS enhanced staging accuracy on PEIs(up to 77.07%with MPR),it provided no significant additional benefit for VMIs.CONCLUSION DLSCT VMIs at 40-50 keV significantly enhanced image quality and improved preoperative T staging accuracy of CRC when combined with MPR.These findings underscored the clinical value of low-keV spectral imaging in tailoring individualized treatment strategies.展开更多
AIM： To assess the diagnostic performance of follow- up liver computed tomography （CT） for the detection of high-risk esophageal varices in patients treated with Io- coregional therapy for hepatocellular carcinoma ...AIM： To assess the diagnostic performance of follow- up liver computed tomography （CT） for the detection of high-risk esophageal varices in patients treated with Io- coregional therapy for hepatocellular carcinoma （HCC）. METHODS： We prospectively enrolled 100 patients with cirrhosis who underwent transcatheter arterial chemoembolization, radiofrequency ablation or both procedures for HCCs. All patients underwent upper endoscopy and subsequently liver CT. Three radiolo- gists independently evaluated the presence of high-riskesophageal varices with transverse images alone and with three orthogonal multiplanar reformation （MPR） images, respectively. With endoscopic grading as the reference standard, diagnostic performance was as- sessed by using receiver operating characteristic （ROC） curve analysis. RESULTS： The diagnostic performances （areas under the ROC curve） of three observers with transverse im- ages alone were 0.947 ± 0.031, 0.969 ± 0.024, and 0.916 ＋ 0.038, respectively. The mean sensitivity, spec- ificity, positive predicative value （PPV）, and negative predicative value （NPV） with transverse images alone were 90.1%, 86.39%, 70.9%, and 95.9%, respectively. The diagnostic performances, mean sensitivity, specific- ity, PPV, and NPV with three orthogonal MPR images （0.965 ± 0.025, 0.959 ± 0.027, 0.938 ± 0.033, 91.4%, 89.5%, 76.3%, and 96.6%, respectively） were not su- perior to corresponding values with transverse images alone （P 〉 0.05）, except for the mean specificity （P = 0.039）. CONCLUSION： Our results showed excellent diagnos- tic performance, sensitivity and NPV to detect high-risk esophageal varices on follow-up liver CT after Iocore- gional therapy for HCC,展开更多
基金Supported by Jiangsu Province 333 Talent Key Industry Field Talent Project,No.[2022]21Key Scientific Research Program of Jiangsu Provincial Health Committee,No.ZD2021059+2 种基金Nantong Key Laboratory Project,No.[2020]163The Project of Nantong City Health Committee,No.MS2023027Young Medical Talents Fund of Health and Family Planning Commission of Nantong,No.QA2019006 and No.QNZ2023027.
文摘BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer(CRC).Low-keV virtual monoenergetic images(VMIs)have been shown to enhance lesion conspicuity.This study aimed to assess the diagnostic value of dual-layer spectral computed tomography(CT)-derived VMIs,in combination with multiplanar reformation(MPR)and evaluation of peritumoral fat stranding(PFS),for improving the accuracy of T staging in CRC.AIM To assess the diagnostic performance of dual-layer spectral CT(DLSCT)VMIs,particularly at low energy levels,and their integration with personalized MPR for preoperative T staging of CRC.METHODS In this retrospective study,157 patients with pathologically confirmed CRC(mean age:63.5±12.1 years)underwent DLSCT within 1 week before surgery.VMIs ranging from 40 keV to 70 keV(at 10 keV intervals)and conventional polyenergetic images(PEIs)were reconstructed.Objective image quality parameters,including image noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR),were quantified,alongside subjective image quality scores using a 5-point Likert scale.Interobserver agreement was evaluated usingκstatistics.Taking histopathology as the reference standard,the diagnostic accuracy of T staging(T1-2 vs T3-4)was compared across PEIs and VMIs,both with and without MPR and PFS.RESULTS Low-keV VMIs(40-70 keV)demonstrated significantly higher SNR and CNR than PEIs(all P<0.001).Notably,40-keV VMIs achieved noise levels comparable to PEIs(8.17±3.63 vs 8.53±2.90;P=0.673).Subjective image quality peaked at 40-50 keV VMIs(Likert scores 4.85-4.88 vs 3.97 for PEIs;P<0.001),supported by excellent interobserver agreement(κ=0.812-0.913).The combination of 40-50 keV VMIs with MPR yielded the highest T staging accuracy(94.27%)compared to axial PEIs(70.7%),with a sensitivity and specificity of 83.87%and 96.83%,respectively(Youden index=0.81;P<0.05).While PFS enhanced staging accuracy on PEIs(up to 77.07%with MPR),it provided no significant additional benefit for VMIs.CONCLUSION DLSCT VMIs at 40-50 keV significantly enhanced image quality and improved preoperative T staging accuracy of CRC when combined with MPR.These findings underscored the clinical value of low-keV spectral imaging in tailoring individualized treatment strategies.
基金Supported by Grant from the Samsung Medical Center Clinical Research Development Program,No. CRS108-12-1
文摘AIM： To assess the diagnostic performance of follow- up liver computed tomography （CT） for the detection of high-risk esophageal varices in patients treated with Io- coregional therapy for hepatocellular carcinoma （HCC）. METHODS： We prospectively enrolled 100 patients with cirrhosis who underwent transcatheter arterial chemoembolization, radiofrequency ablation or both procedures for HCCs. All patients underwent upper endoscopy and subsequently liver CT. Three radiolo- gists independently evaluated the presence of high-riskesophageal varices with transverse images alone and with three orthogonal multiplanar reformation （MPR） images, respectively. With endoscopic grading as the reference standard, diagnostic performance was as- sessed by using receiver operating characteristic （ROC） curve analysis. RESULTS： The diagnostic performances （areas under the ROC curve） of three observers with transverse im- ages alone were 0.947 ± 0.031, 0.969 ± 0.024, and 0.916 ＋ 0.038, respectively. The mean sensitivity, spec- ificity, positive predicative value （PPV）, and negative predicative value （NPV） with transverse images alone were 90.1%, 86.39%, 70.9%, and 95.9%, respectively. The diagnostic performances, mean sensitivity, specific- ity, PPV, and NPV with three orthogonal MPR images （0.965 ± 0.025, 0.959 ± 0.027, 0.938 ± 0.033, 91.4%, 89.5%, 76.3%, and 96.6%, respectively） were not su- perior to corresponding values with transverse images alone （P 〉 0.05）, except for the mean specificity （P = 0.039）. CONCLUSION： Our results showed excellent diagnos- tic performance, sensitivity and NPV to detect high-risk esophageal varices on follow-up liver CT after Iocore- gional therapy for HCC,
