目的 分析双源CT能谱成像多参数对宫颈癌区域淋巴结的定性诊断价值。方法 选择2021年5月至2022年5月新疆维吾尔自治区人民医院收治的102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者，年龄27～68岁，平均年龄51。23岁;身体质量指数21～29 kg/m2，平均身体质量指数22。86 kg/m2;根据国际妇产科联盟(FIGO)分期标准，Ⅰ期15例，Ⅱ期39例，Ⅲ期42例，Ⅳ期6例;组织病理学类型，鳞癌86例，腺癌12例，腺鳞癌3例，透明细胞癌1例。所有患者均进行双源CT能谱成像检查，行动脉期及静脉期增强扫描，检测标准化碘浓度(NIC)和能谱曲线斜率(λHU);根据术后淋巴结的病理结果，分为淋巴结转移组和淋巴结未转移组，比较两组动脉期及静脉期的NIC、λHU，使用受试者工作特性(ROC)曲线分析其诊断效能。结果 在102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者中，CT检出淋巴结共531个。根据术后淋巴结的病理诊断，分为淋巴结转移组345个和淋巴结未转移组186个。淋巴结转移组动脉期及静脉期的NIC、λHU均大于淋巴结未转移组，差异均有统计学意义(动脉期:0。41±0。19 vs 0。20±0。12，6。78±1。43 vs 2。41± 0。55。静脉期:0。68±0。56 vs 0。39±0。27，5。85±1。37 vs 3。72±0。61。P＜0。05);经 ROC 曲线分析，动脉期 NIC、λHU 及静脉期NIC、λHU定性诊断宫颈癌区域淋巴结的ROC曲线下面积(AUC)分别为0。925、0。905和0。935、0。930，最佳截断值分别为0。44、7。53 和 0。76、5。95，灵敏度分别为 76。65％、68。91％和 72。53％、75。76％，特异度分别为 81。92％、93。47％和 74。58％、82。43％。结论 运用双源CT能谱成像多参数进行定量分析，在宫颈癌区域淋巴结定性诊断中具有较大意义，可作为术前判断区域淋巴结转移的重要依据之一。
Value of multi-parameter dual-source CT spectral imaging in qualitative diagnosis of cervical cancer regional lymph node
Objective To analyze the qualitative diagnostic value of dual-source CT energy spectrum imaging with multi-pa-rameter in cervical cancer regional lymph node.Methods From May 2021 to May 2022,a total of 102 patients with cervical cancer regional lymph node confirmed by pathological biopsy were enrolled,which aged 27-68 years old with mean age of 51.23 years old;body mass index(BMI)was 21-29 kg/m2 with mean BMI of 22.86 kg/m2.According to International Federa-tion of Gynecology and Obstetrics(FIGO)staging criteria,there were 15 cases of stage Ⅰ,39 of stage Ⅱ,42 of stage Ⅲ and 6 of stage Ⅳ.The histopathological types were 86 cases of squamous cell carcinoma,12 of adenocarcinoma,3 of adenosquamous carcinoma and 1 of clear cell carcinoma.All of them performed dual-source CT energy spectrum imaging,arterial and venous phase enhanced scan,the standardized iodine concentration(NIC)and energy spectrum curve slope(λHU)were detected.Ac-cording to the pathological results of lymph nodes after operation,all of them were divided into lymph node metastasis group and lymph node non-metastasis group.The NIC and λHU in arterial and venous phases between 2 groups were compared,and diagnostic efficacy was analyzed by receiver operating characteristic(ROC)curve.Results A total of 531 lymph nodes were detected by CT in 102 patients.According to the pathological diagnosis of postoperative lymph node,all of them were divided into lymph node metastasis group(n=345)and lymph node non-metastasis group(n=186).The NIC and λHU in arterial and venous phase of lymph node metastasis group were statistically significantly higher than those in non-lymph node metastasis group(arterial phase:0.41±0.19 vs 0.20±0.12,6.78±1.43 vs 2.41±0.55;venous phase:0.68±0.56 vs 0.39±0.27,5.85± 1.37 vs 3.72±0.61.P＜0.05).The ROC curve analysis showed that the area under curve(AUC)of arterial phase NIC,λHU and venous phase NIC,λHU qualitative diagnosis of cervical cancer regional lymph node were 0.925,0.905 and 0.935,0.930,respectively.The optimal cut-off values of above parameters were 0.44,7.53 and 0.76,5.95,sensitivity were 76.65％,68.91％and 72.53％,75.76％,and specificity were 81.92％,93.47％and 74.58％,82.43％,respectively.Conclusion It is demonstrated that the quantitative analysis of multi-parameter by dual-source CT spectral imaging is of great significance in qualitative diagnosis of cervical cancer regional lymph node,which could be used as one of the important basis for preoperative diagnosis of regional lymph node metastasis.
NETL
NSTL
万方数据
维普
