能谱曲线与常规形态学方法对结直肠癌转移淋巴结诊断准确性的对比  

Comparison of the Accuracy of Spectrum Curve and Morphological Way in the Diagnosis of Metastasis Lymph Nodes of Colorectal Cancer

作　　者：杨雪君[1] 赵珍[2] 赵卫[1] 李青青[1] 郑凌琳 杨亚英[1] 

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032 [2]昆明医科大学学报编辑部,云南昆明650032

出　　处：《昆明医科大学学报》2015年第12期107-111,共5页Journal of Kunming Medical University

基　　金：云南省卫生科技计划基金资助项目(2014NS158)

摘　　要：目的比较双源CT双能量扫描所获能谱曲线与常规形态学方法对结肠直肠癌转移淋巴结诊断的准确性.方法收集有完整双源CT双能量扫描资料并经手术病理证实的22例结肠直肠癌,共40枚腹部区域淋巴结,在CT图像上测量淋巴结的大小,平扫及动脉期CT值;计算淋巴结短长径之比及强化值(淋巴结动脉期CT值-平扫期CT值);将双能量扫描动脉期图像调进双能后处理软件"Mono Energetic",得到原发病灶与淋巴结能谱曲线,对能谱曲线进行分析;比较形态学方法与能谱曲线诊断转移淋巴结的符合率.结果 40枚腹部实性淋巴结中,腺癌转移性淋巴结17枚,反应性增生淋巴结23枚.用淋巴结短长径之比及CT值强化值诊断转移淋巴结的方法与病理结果一致性较弱(Kappa值0.100、0.016),灵敏度为64.7%、35.3%,特异度为22.7%,68.2%,ROC曲线下面积分别为0.434、0.501;而用能谱曲线诊断转移淋巴结与病理结果一致性较强(Kappa值0.899),灵敏度与特异度分别为94.1%、95.5%,ROC曲线下面积为0.949.结论双源CT双能量扫描能谱曲线对结直肠癌转移淋巴结诊断的准确率、灵敏度及特异度均优于常规形态学诊断方法,能够为临床治疗方案的选择及其预后提供更客观的依据.Objective To compare the accuracy of spectrum curve and morphological way in dual-energy CT in the differential diagnosis of the metastatic lymph nodes of colorectal cancer. Methods Twenty-two patients with pathologically confirmed colorectal cancer were included. A total of 40 lymph nodes enlargement were observed from the patients using dual-energy CT scan, then the size of the lymph nodes on CT images and the CT values in plain scan and arterial phase CT scan were measured. The short-long diameter ratio and reinforcement value of lymph node （lymph node CT value in arterial phase - CT value in plain scan） were calculated. Then observed the change trend of the spectrum curve and compared the accuracy of two kinds of methods in the diagnosis of metastasis lymph nodes in colorectal cancer. Results In the 40 lymph nodes, the metastatic lymph nodes in colorectal cancer and reactive hyperplasia of lymph node were found in 17 and 23 cases, respectively. In the diagnosis of lymph node metastasis, the short-long diameter ratio and strengthen of CT value showed weak consistency with the pathological results （Kappa value = 0.100 and 0.016） . The sensitivity was 64.7% and 35.3%, the specificity was 22.7% and 68.2%,and the area under the ROC curve was 0.434 and 0.501, respectively. However, the spectrum curve had strong consistency with the palhological results in the diagnosis of lymph node metastasis （Kappa value=0.899） , with the sensitivity, specificity and the area under the ROC curve was 94.1%, 95.5% and 0.949, respectively. Conclusion The spectrum curve of dual-energy CT scanning is more accurate, sensitive and specific than the conventional morphology in the diagnosis of metastasis lymph nodes of＂ colorectal cancer.

关 键 词：结直肠癌转移淋巴结 能谱曲线 双能量扫描 形态学分析 

分 类 号：R735.3[医药卫生—肿瘤]