摘要
目的:探讨光谱CT多参数成像术前预测结肠癌神经侵犯(PNI)及脉管侵犯(LVI)状态的价值.方法:搜集 2021 年 9 月至 2022 年 9 月在昆明医科大学第一附属医院行光谱 CT 扫描并经术后病理确诊为结肠癌的 64 例患者的临床及影像资料,根据术后病理中 PNI/LVI 的状态分为阳性组(29例)和阴性组(35 例).测量光谱 CT 动脉期、静脉期 40 keV、90 keV 单能级图像上病灶的 CT 值(CT40keV、CT90keV)、碘浓度(IC)、标准化碘浓度(NIC)、有效原子序数(Zeff)及标准化有效原子序数(NZeff),并计算光谱曲线斜率λ.比较两组间各光谱参数的差异,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)、敏感度、特异度及最佳阈值,以评估各参数的预测效能.结果:结肠癌 PNI/LVI阳性组的动脉期和静脉期光谱CT定量参数CT40keV、IC、NIC、Zeff、NZeff及λ均高于阴性组,差异均有统计学意义(P 均＜0.05),而两组间动脉期和静脉期的 CT90keV差异无统计学意义(P 均＞0.05).ROC曲线分析结果显示,动脉期各参数预测结肠癌PNI/LVI状态的效能高于静脉期,其中以动脉期IC的预测效能最佳,其 AUC 值、敏感度和特异度分别为 0.783(95%CI:0.672～0.894)、82.76%和 65.71%.结论:光谱CT定量参数CT40keV、IC、NIC、Zeff、NZeff及λ在术前预测结肠癌 PNI/LVI 状态中具有一定价值,以动脉期IC的预测效能最佳.
Abstract
Objective:To investigate the value of spectral CT multi-parameter imaging in preop-erative prediction of perineural and lymphovascular invasion in colon cancer.This study aims to inves-tigate the value of spectral CT multi-parameter imaging in preoperative prediction of perineural and lymphovascular invasion(PNI/LVI)in colon cancer.Methods:The clinical and imaging data of 64 co-lon cancer patients confirmed by pathology in the First Affiliated Hospital of Kunming Medical Uni-versity from September 2021 to September 2022 were collected.According to the presence of PNI/LVI,these patients were divided into the positive group(29 cases)and the negative group(35 cases).The CT values of 40keV and 90keV(CT40keV,CT90keV),iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number(Zeff),and normalized effective atomic number(NZeff)were measured in the arterial and venous phases on spectral CT images,then the spectrum curve slope λwas calculated.The difference of each spectral parameter between the two groups was compared,and the ROC curve with the area under the curve(AUC),sensitivity,specificity,and the optimal threshold were calculated to evaluate the predictive performance of each parameter.Results:Compared to the PNI/LVI-negative group,the PNI/LVI-positive group had higher CT40keV,IC,NIC,Zeff,NZeff,and λ values on arterial and venous phases(all P＜0.05).There was no significant difference in CT90keV be-tween the two groups in both phases(all P＞0.05).The ROC curve showed that the predictive efficacy of each parameter in the arterial phase was higher than that in the venous phase,and the IC in the arte-rial phase had the highest predictive value in predicting PNI/LVI,with an AUC of 0.783(95%CI:0.672～0.894),sensitivity and specificity of 82.76%and 65.71%,respectively.Conclusion:The quanti-tative parameters of CT40keV,IC,NIC,Zeff,NZeff andλvalues on spectral CT have certain value in pre-dicting preoperative PNI/LVI status of colon cancer,and the IC in arterial phase has the best predic-tive efficacy.
基金项目
云南省放射与治疗临床医学研究中心专项子课题(202102 AA100067)
昆明医科大学研究生创新基金(2022 S230)
NETL
NSTL
维普
万方数据