能谱CT预测同步放化疗用于中晚期食管癌效果  

Spectral CT in predicting efficacy of chemoradiotherapy for advanced esophageal cancer

作　　者：马宁[1] 郑德春[1] 鲍道亮[1] 钟婧[1] 肖友平[1] 苏丽清 陈兴发[1] 伍榕霞 MA Ning;ZHENG Dechun;BAO Daoliang;ZHONG Jing;XIAO Youping;SU Liqing;CHEN Xingfa;WU Rongxia(Department of Radiology,Fujian Medical University Cancer Hospital,Fujian Cancer Hospital,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属肿瘤医院福建省肿瘤医院放射诊断科,福建福州350000

出　　处：《中国医学影像技术》2022年第11期1647-1651,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的 观察能谱CT预测同步放化疗(CRT)用于中晚期食管癌效果的价值。方法 回顾性分析于CRT前后均接受能谱CT增强扫描的89例中晚期食管癌患者,根据疗效分为有效组(完全缓解+部分缓解)和无效组(疾病进展+疾病稳定)。在GE AW4.7后处理工作站于碘图中勾画病灶ROI,获得CRT前(pre-)、后(post-)病灶动脉期标准化碘值(SAI)及静脉期标准化碘值(SVI),计算CRT前后标准化碘值变化率(△SAI%、△SVI%);再于单能量图像上勾画病灶ROI,获得病灶动脉期(k)及静脉期(k)能谱曲线斜率,计算CRT前后能谱曲线斜率变化量(△k、△k)。采用受试者工作特征(ROC)曲线评价各参数评估CRT疗效的效能。结果 CRT后完全缓解5例,部分缓解51例,疾病进展31例,疾病稳定2例,即有效组56例、无效组33例;组间pre-SAI、post-SVI、△SAI%、△SVI%、post-k、post-k、△k及△k差异均有统计学意义(P均<0.05)。ROC曲线显示,上述组间差异具有统计学意义的参数中,△SAI%预测CRT疗效的效能相对较高,其曲线下面积(AUC)为0.81;阈值取-0.08时,其敏感度为64.29%,特异度为84.85%。结论 利用能谱CT,通过定量分析病灶能谱CT碘值和曲线斜率,可预测CRT用于中晚期食管癌的效果。Objective To analyze the value of spectral CT in predicting efficacy of chemoradiotherapy(CRT) for advanced esophageal cancer. Methods Data of 89 patients with advanced esophageal cancer who underwent spectral CT enhanced scan before and after CRT were retrospectively analyzed. According to the efficacy, the patients were divided into effective group(complete remission and partial remission) and ineffective group(progressive disease and stable disease). ROI of lesions were outlined on iodine map at GE AW4.7 post-processing workstation, and the standardized arterial iodine(SAI) and standardized venous iodine(SVI) before(pre-) and after(post-) CRT were obtained. The change rates of standardized iodine value(△SAI% and △SVI%) before and after CRT were calculated. ROI of lesions were also delineated on the single energy images, the slopes of the energy spectrum curve in arterial phase(k) and venous phase(k) of the lesion were obtained, and the changes of the slope of the energy spectrum curve(△k, △k) before and after CRT were calculated. Receiver operating characteristic(ROC) curve was used to evaluate the efficacy of the parameters for predicting the efficacy of CRT. Results After CRT, complete remission was observed in 5 cases, partial remission in 51 cases, while progressive disease and stable disease were found in 31 cases and 2 cases, respectively. There were 56 cases in effective group and 33 cases in ineffective group. Significant differences of pre-SAI, post-SVI, △SAI%, △SVI%, post-k, post-k, △kand △kwere detected between groups(all P<0.05). ROC curve showed that among the parameters being significantly different between groups, △SAI% had relatively high predictive value for the efficacy of CRT, and the area under the curve(AUC) was 0.81. Taken-0.08 as the threshold, the sensitivity was 64.29%, and the specificity was 84.85%. Conclusion The efficacy of CRT for advanced esophageal cancer could be predicted using spectral CT quantitative analysis of iodine value and slope.

关 键 词：食管肿瘤 体层摄影术 X线计算机 放射治疗 药物治疗 

分 类 号：R735.1[医药卫生—肿瘤] R814.42[医药卫生—临床医学]