CT能谱成像术前评估食管鳞状细胞癌病理分级的临床价值  

Clinical value of spectral CT imaging in preoperative evaluation of pathological grading of esophagealsquamous cell carcinoma

作　　者：刘月华 朱绍成[2] 史大鹏[2] 魏毅[2] 孙明华[2] 务森[3] 李琳琳 

机构地区：[1]河南大学医学院,开封475000 [2]河南省人民医院放射科 [3]河南省人民医院胸瘤中心

出　　处：《中华医学杂志》2017年第43期3406-3411,共6页National Medical Journal of China

摘　　要：目的探讨宝石能谱cT定量参数术前评估食管鳞状细胞癌病理分级的价值。方法前瞻性研究河南省人民医院2016年6月至2017年5月52例经手术病理证实的食管鳞状细胞癌患者的影像资料，其中男43例，女9例，年龄（66±8）49—76岁；高分化12例，中分化20例，低分化20例。所有患者术前均行胸部平扫和宝石能谱CT双期增强扫描，测量并计算病灶强化值（HU）、能谱曲线平均斜率（xHU）、标准化碘浓度（NIC）、标准化有效原子序数（Z肌）。比较不同病理分级间各参数的差异，受试者工作特征曲线（ROE曲线）用于评价各单独、联合参数鉴别低分化与中一高分化食管鳞状细胞癌的诊断价值。结果动脉期及静脉期不同病理分级食管鳞状细胞癌之间的HU、入HU、NIC和z差异均有统计学意义（F=4．496—9．056，H=23．204、20．724，均P〈0．05）。单独参数中动脉期NIC鉴别低分化与中一高分化食管鳞状细胞癌的诊断效能最高，ROC曲线下面积（AUC）0．860、阈值0．197、敏感度65．0％、特异度96．9％、准确度84．6％；联合参数中动脉期（HU＋NIC＋入HU）的诊断效能最高，其AUC0．913、预测概率阈值0．380、敏感度85．0％、特异度81．3％、准确度82．7％。结论宝石能谱CT定量参数可用于术前评估食管鳞状细胞癌病理分级，其中动脉期NIC及HU＋NIC＋入his的鉴别诊断效能最高。Objective To investigate the value of spectral computed tomography quantitative parameters in the assessment of pathological grade of esophageal squamous cell carcinoma before operation. Methods The imaging findings of 52 patients with confirmed esophageal squamous cell carcinoma by surgery and pathology were prospectively analyzed in Henan Provincial People＇s Hospital from June 2016 to May 2017. There were 43 males and 9 females, aged 49 -76 years, with an average age of （66 ± 8） years. All the patients were divided into three groups based on the pathological finding： well-differentiated group （ n = 12 ） , moderately-differentiated group （ n = 20 ） , poorly-differentiated group （ n = 20 ）. All the patients received chest plain scan and double phase enhanced scan of gemstone spectral computed tomography. The enhancement attenuation （ HU）, the average of the slope of the spectral Hounsfield Unit curve （~nu）, normalized iodine concentration （NIC）, normalized effective atomic number （Zof_a） were measured and calculated. The difference in HU, knu, NIC, Zoff.a among different grades were statistically analyzed. The receiver operating characteristic （ROC） curve was used to evaluate the diagnostic efficiency of single and combined parameters in the differentiation of poorly-differentiated and well-moderately differentiated esophageal squamous cell carcinoma. Results There were significant differences in HU, kHu, NIC, Z among different pathological grading of the esophageal squamous cell carcinoma in arterial phase and venous phase （F = 4. 496 - 9. 056, H = 23. 204, 20. 724, all P 〈 0. 05 ）. The best single parameter to differentiate poorly-differentiated from well-moderately differentiated esophageal squamous cell carcinoma was NIC in arterial phase with areas under the ROC curve （AUC）, the cutoff value, sensitivity, specificity,accuracy of 0. 860, 0. 197, 65.0%, 96. 9%, 84. 6%, respectively; the best combination of parameters was HU ＋NIC ＋ knu in arterial phase wit

关 键 词：食管鳞状细胞癌 体层摄影术 X线计算机 宝石能谱CT 病理分级 

分 类 号：R730.44[医药卫生—肿瘤] R735.1[医药卫生—临床医学]