Relationship between CT Value,Curve Slope Measured by Spectral CT and Angiogenesis and Prognosis in Patients with Spinal Metastases
Objective To investigate the relationship between CT value,spectral curve slope measured by spectral CT and angiogenesis markers and prognosis in patients with spinal metastasis(SM).Methods A total of 85 patients with SM in our hospital from May 2021 to May 2023 were selected as the study group,and 85 patients with malignant tumor without bone metastasis were selected as the control group during the same period.Energy spectrum CT was performed in both groups,and the basic data,CT value(40-90 keV),curve slope of the two groups were compared.The expression of angiogenesis markers such as vascular endothelial growth factor(VEGF),metallomatrix proteinase-9(MMP-9)in SM tumor tissues and adjacent normal tissues of the study group was compared,and the correlation between energy spectrum CT parameters and angiogenesis markers in SM tumor tissues was analyzed.The study group was followed up for 1 year,the prognosis was statistically analyzed,the clinical data of death and survival patients were compared,the prognosis of SM patients was analyzed as the influencing factor of death,and the value of energy spectrum CT parameters in predicting the prognosis of SM patients was analyzed.Results The CT value(40-90 keV)and curve slope of the study group were lower than those of the control group(P＜0.05).The positive expression rates of VEGF and MMP-9 in tumor tissues(76.47％and 83.53％)were higher than those in adjacent normal tissues(44.71％and 17.65％)(P＜0.05).In the study group,CT values(40-90 keV)and curve slope were negatively correlated with the positive expression of VEGF and MMP-9 in SM tumor tissues(P＜0.05).Among the patients who completed follow-up in the study group,the time from diagnosis to metastasis of the deceased patients was shorter than that of the surviving patients,the proportion of internal metastasis and extra-spinal bone metastasis was higher than that of the surviving patients,and the proportion of postoperative local radiotherapy,CT value of 40 keV,CT value of 50 keV and curve slope was lower than that of the surviving patients(P＜0.05).The time from diagnosis to metastasis,visceral metastasis,extra-spinal bone metastasis,postoperative local radiotherapy,CT value of 40 keV and curve slope were all independent influencing factors of prognosis and death in SM patients(P＜0.05).The AUC of 40 keV and curve slope alone predicting the prognosis of death was 0.805 and 0.798,respectively,and the AUC of combined prediction was 0.931,which was greater than the AUC predicted by the two alone(P＜0.05).Conclusion CT value(40-90 keV)and curve slope measured by energy spectrum CT are closely related to the angiogenesis markers of SM tumor tissue,in which CT value of 40 keV and curve slope are independent influencing factors of prognosis and death in SM patients,and the combination of the two can provide a reliable reference for clinical prognosis prediction.
Spinal metastasisEnergy spectrum CTCT valueSlope of energy spectrum curveNeoangiogenesisPrognosis
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