双能CT增强扫描对鼻咽癌颈部转移淋巴结放疗敏感性的预测研究  

The predictive study of dual-energy CT contrast-enhanced scans in evaluating radiosensitivity of cervical The predictive study of dual-energy CT contrast lymph nodes metastases in nasopharyngeal carcinoma

作　　者：王仕军[1] 汤春贵 郜发宝[2] 李自康[1] 张丽[1] 谢应朗 马婉军 郝淑彬 WANG Shijun;TANG Chungui;GAO Fabao;LI Zikang;ZHANG Li;XIE Yinglang;MA Wanjun;HAO Shubin(Department of Radiology,Yaan People’s Hospital,Yaan 625000,China;Department of Radiology,West China Hospital,Sichuan University)

机构地区：[1]雅安市人民医院放射科,雅安625000 [2]四川大学华西医院放射科

出　　处：《国际医学放射学杂志》2019年第3期269-273,共5页International Journal of Medical Radiology

摘　　要：目的探讨双能CT增强扫描对鼻咽癌颈部转移淋巴结放疗敏感性的预测和应用价值。方法选取2014年5月—2017年12月在我院进行放疗的有颈部转移淋巴结的鼻咽癌病人52例,其中男28例,女24例,年龄29～77岁,平均(52.65±10.07)岁。按照放疗疗效分为无效组[13例,男8例,女5例,平均年龄(47.77±6.83)岁]和有效组[39例,男20例,女19例,平均年龄(54.62±10.66)岁]。放疗前模拟定位时行颈部双能CT(DECT)增强扫描,通过专用后处理软件对扫描数据进行能谱曲线特征分析。采用χ2检验比较2组不同T分期的分布差异,2组的标化碘基物质浓度(sIC)、能谱曲线斜率(λHU)及能谱曲线下面积(AUC)比较均采用独立样本t检验。通过放疗前淋巴结的sIC及λHU值的受试者操作特征(ROC)曲线分析评估放疗疗效的敏感度和特异度。结果 2组间不同T分期的分布差异无统计学意义(P>0.05)。有效组的sIC和λHU均高于无效组(均P<0.05),放疗无效组和有效组能谱曲线的曲线下面积(AUC)差异无统计学意义(P>0.05)。sIC的ROC曲线AUC=0.753,以放疗前淋巴结的sIC≥26.50×10-2为阈值,敏感度为74.4%,特异度为84.6%;λHU的ROC曲线AUC=0.689,以放疗前淋巴结的λHU≥4.90为阈值,敏感度为69.2%,特异度为76.9%。结论通过双能CT增强扫描获得的sIC及λHU值可以有效预测鼻咽癌颈部转移淋巴结的放疗效果,为临床个体化治疗提供新的思路和依据。Objective To investigate the prediction and application values of dual-energy CT(DECT)contrastenhanced scans in evaluating radiosensitivity of cervical lymph nodes metastases in nasopharyngeal carcinoma(NPC).Method Between May 2014 and Dec.2017,52 NPC patients who had metastatic lymph nodes in the neck(28 males and 24 females;mean age,52.65±10.07 years,range 29-77 years)and underwent radiotherapy in our hospital were enrolled in the study.According to the curative effect,the patients were divided into effective[13 patients,8 males,5 females,average age 47.77±6.83 years]and ineffective group[39 patients,20 males,19 female,average age 54.62±10.66 years].Dual-energy CT(DECT)enhanced scan of the neck was performed during the simulated positioning before radiotherapy,and the characteristics of energy spectrum curve were analyzed with a special post-processing software.The chi-square test was used to compare the difference in distribution of different T stages between the two groups.Independent sample t test was used for the comparison of standard iodide concentration(sIC),slope of energy spectrum curve(λHU),and area under curve(AUC)between the two groups.Sensitivity and specificity of radiotherapy efficacy were assessed by the sIC orλHU value of the lymph nodes before radiotherapy using operating characteristic curve(ROC).Results There was no significant difference in the distribution of different T stages between the two groups(P>0.05).The sIC andλHU were higher in the effective group than in the ineffective group(all P<0.05).There was no significant difference in AUC between the radiotherapy ineffective and effective groups(P>0.05).Using sIC 26.50×10^-2 as the threshold of lymph nodes before radiotherapy,the AUC was 0.753,the sensitivity was 74.4%,and the specificity was 84.6%.UsingλHU 4.90 as the threshold of the lymph nodes before radiotherapy,the AUC was 0.689,the sensitivity was 74.4%,and the specificity was 84.6%.Conclusion The sIC andλHU,acquired from DECT contrast-enhanced scans,can be used to predic

关 键 词：双能CT 鼻咽癌 转移淋巴结 能谱曲线 

分 类 号：R730.55[医药卫生—肿瘤] R739.6[医药卫生—临床医学]