Value of nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features in preoperative prediction of tumor deposits in colorectal cancer
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目的 探讨双层探测器光谱CT定量参数联合常规CT特征的列线图模型在术前预测结直肠癌肿瘤沉积（TDs）中的价值。 方法 本研究为病例对照研究。回顾性收集苏州大学附属第一医院2022年1月至2023年3月术前接受光谱CT腹部增强扫描且经病理确诊的126例结直肠癌患者，根据病理结果分为TDs阳性组（n=38）和TDs阴性组（n=88）。评估其常规CT特征，包括cT分期、cN状态、静脉期强化是否均匀、瘤周脂肪浸润（PFI）、肿瘤最大径以及肿瘤位置。测量并计算病灶动脉期、静脉期标准化碘浓度（NIC）、标准化有效原子序数（NZeff）、40~100 keV光谱曲线斜率（K）和动静脉期NIC差值。采用多因素logistic回归分析筛选出TDs的独立预测因素并构建基于光谱CT定量参数及常规CT特征的列线图模型，利用受试者操作特征曲线评估各参数及模型的预测效能，采用DeLong检验比较曲线下面积（AUC）的差异。 结果 TDs阳性组与TDs阴性组间cT分期、cN状态、静脉期强化是否均匀、PFI、静脉期NIC、静脉期NZeff、静脉期K和动静脉期NIC差值差异有统计学意义（P<0.05）。经过logistic回归分析，常规CT特征模型纳入2个特征，分别为静脉期强化不均匀（OR=9.602，95%CI 3.728~24.734，P=0.001）和PFI（OR=2.881，95%CI 1.177~7.049，P=0.020）。常规CT特征与光谱CT定量参数的联合模型纳入3个特征，分别为动静脉期NIC差值（OR=37.599，95%CI 8.320~169.912，P=0.001）、静脉期强化不均匀（OR=14.978，95%CI 3.848~58.295，P=0.001）、PFI（OR=4.013，95%CI 1.320~12.760，P=0.015），并构建列线图。列线图模型的预测TDs的AUC、灵敏度、特异度分别为0.919（95%CI 0.865~0.973）、84.2%、86.5%，常规CT特征模型预测TDs的AUC为0.796（95%CI 0.707~0.885），低于列线图模型，差异有统计学意义（Z=3.87，P=0.001）。 结论 双层探测器光谱CT可用于术前预测结直肠癌TDs，以光谱CT定量参数联合常规CT特征的列线图模型诊断效能最佳。 Objective To investigate the value of the nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features in preoperatively predicting tumor deposits (TDs) in colorectal cancer. Methods This study was a case-control study. A total of 126 patients with pathologically confirmed colorectal cancer who underwent preoperative spectral CT scan from January 2022 to March 2023 in the First Affiliated Hospital of Soochow University were enrolled retrospectively. Patients were divided into TDs-positive group (n=38) and TDs-negative group (n=88) based on pathological results. The following conventional CT features were assessed: cT stage, cN status, uniformity of enhancement in the venous phase, pericolorectal fat invasion (PFI), maximum tumor diameter, and tumor location. The following quantitative parameters were also measured and calculated: the normalized iodine concentration (NIC) of lesions, the normalized effective atomic number (NZeff), and the slope of the 40-100 keV spectral curve (K) in the arterial and venous phases, and the difference in NIC between the arterial and venous phases. Multivariate logistic regression analysis was used to select independent predictors of TDs and the nomogram based on spectral CT quantitative parameters and conventional CT features was constructed. The receiver operating characteristic curve was performed to evaluate the diagnostic performance of each parameter and model. DeLong test was used to compare the differences of area under the curve (AUC). Results Statistically significant differences were found between the TDs-positive and TDs-negative groups for the cT stage, cN status, uniformity of enhancement in the venous phase, PFI, NIC, NZeff, K in the venous phase and the difference in NIC between the arterial and venous phases (P<0.05). After multivariate logistic regression analysis, the conventional CT feature model incorporated two features: uniformity of enhancement in the venous phase(OR=9.602, 95%CI 3.728-24.734, P=0.001) and PFI (OR=2.881, 95%CI 1.177-7.049, P=0.020). The combined model of conventional CT features and spectral CT quantitative parameters incorporated three features: the difference in NIC between the arterial and venous phases (OR=37.599, 95%CI 8.320-169.912, P=0.001), uniformity of enhancement in the venous phase (OR=14.978, 95%CI 3.848-58.295, P=0.001), and PFI (OR=4.013, 95%CI 1.320-12.760, P=0.015), and the nomogram was constructed. The AUC, sensitivity, and specificity of the nomogram for predicting TDs were 0.919 (95%CI 0.865-0.973), 84.2%, and 86.5%, respectively. The AUC of the conventional CT feature model was 0.796 (95%CI 0.707-0.885), which was lower than that of the nomogram, and the difference was statistically significant (Z=3.87, P=0.001). Conclusion Dual-layer spectral detector CT can be used to predict TDs in colorectal cancer preoperatively, and the nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features shows good diagnostic performance.
Objective To investigate the value of the nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features in preoperatively predicting tumor deposits (TDs) in colorectal cancer. Methods This study was a case-control study. A total of 126 patients with pathologically confirmed colorectal cancer who underwent preoperative spectral CT scan from January 2022 to March 2023 in the First Affiliated Hospital of Soochow University were enrolled retrospectively. Patients were divided into TDs-positive group (n=38) and TDs-negative group (n=88) based on pathological results. The following conventional CT features were assessed: cT stage, cN status, uniformity of enhancement in the venous phase, pericolorectal fat invasion (PFI), maximum tumor diameter, and tumor location. The following quantitative parameters were also measured and calculated: the normalized iodine concentration (NIC) of lesions, the normalized effective atomic number (NZeff), and the slope of the 40-100 keV spectral curve (K) in the arterial and venous phases, and the difference in NIC between the arterial and venous phases. Multivariate logistic regression analysis was used to select independent predictors of TDs and the nomogram based on spectral CT quantitative parameters and conventional CT features was constructed. The receiver operating characteristic curve was performed to evaluate the diagnostic performance of each parameter and model. DeLong test was used to compare the differences of area under the curve (AUC). Results Statistically significant differences were found between the TDs-positive and TDs-negative groups for the cT stage, cN status, uniformity of enhancement in the venous phase, PFI, NIC, NZeff, K in the venous phase and the difference in NIC between the arterial and venous phases (P<0.05). After multivariate logistic regression analysis, the conventional CT feature model incorporated two features: uniformity of enhancement in the venous phase(OR=9.602, 95%CI 3.728-24.734, P=0.001) and PFI (OR=2.881, 95%CI 1.177-7.049, P=0.020). The combined model of conventional CT features and spectral CT quantitative parameters incorporated three features: the difference in NIC between the arterial and venous phases (OR=37.599, 95%CI 8.320-169.912, P=0.001), uniformity of enhancement in the venous phase (OR=14.978, 95%CI 3.848-58.295, P=0.001), and PFI (OR=4.013, 95%CI 1.320-12.760, P=0.015), and the nomogram was constructed. The AUC, sensitivity, and specificity of the nomogram for predicting TDs were 0.919 (95%CI 0.865-0.973), 84.2%, and 86.5%, respectively. The AUC of the conventional CT feature model was 0.796 (95%CI 0.707-0.885), which was lower than that of the nomogram, and the difference was statistically significant (Z=3.87, P=0.001). Conclusion Dual-layer spectral detector CT can be used to predict TDs in colorectal cancer preoperatively, and the nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features shows good diagnostic performance.
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