双层探测器光谱CT对直肠腺癌转移淋巴结的诊断价值  

Diagnostic value of Dual-Layer Detector Spectral CT for lymphatic metastasis in rectal adenocarcinoma

作　　者：梁百晖[1] 杨文[2] 刘岘 戴剑濠 张汉良 陈维翠 卢健烨 陈加良 LIANG Baihui;YANG Wen;LIU Xian;DAI Jianhao;ZHANG Hanliang;CHEN Weicui;LU Jianye;CHEN Jialiang(Department of Radiotherapy,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,China;不详)

机构地区：[1]广西壮族自治区南溪山医院放射治疗科,广西桂林541002 [2]广西壮族自治区南溪山医院放射科,广西桂林541002 [3]广东省中医院(广州中医药大学第二附属医院)放射科,广州510120

出　　处：《实用医学杂志》2023年第3期374-380,共7页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:82202259);广东省中医院朝阳人才项目(编号:ZY2022YL05)。

摘　　要：目的 探讨双层探测器光谱CT(DLSCT)在评估直肠腺癌淋巴结转移中的价值。方法 前瞻性分析78例术前接受DLSCT平扫及双期增强扫描的直肠腺癌患者资料,根据术后病理结果将108枚淋巴结分为转移组(n=52)及非转移组(n=56)。两名影像医生在不知病理结果的情况下独立测量淋巴结短径(SD),评估其边缘、形状及强化均匀度,测量平扫期有效原子序数(Eff-Z),动脉期(AP)及静脉期(VP)的碘浓度(IC),计算双期增强标准化碘浓度(NIC)值。采用两独立样本Mann-Whitney检验及χ^(2)检验比较两组间形态学指标及光谱CT参数的差异,应用受试者工作特征曲线(ROC)分析各指标的诊断效能。结果 转移组与非转移组间的淋巴结SD、边缘,形状及强化均匀度均差异有统计学意义(P<0.05);转移组的NIC_(AP)及NIC_(VP)均显著高于非转移组(P<0.05),而Eff-Z值在两组间差异无统计学意义(P>0.05)。淋巴结的SD、边缘、形状、强化均匀度,NIC_(AP)及NIC_(VP)在评估转移淋巴结的曲线下面积(AUC)分别为0.810、0.648、0.630、0.637、0.806及0.722;将AUC值相对较高的3个参数(NIC_(AP),NIC_(VP)及SD)联合评估淋巴结转移,AUC值最大,达0.911,敏感度80.77%,特异度85.71%。结论 DLSCT标准化碘浓度值有助于提高直肠腺癌淋巴结转移的诊断准确性,光谱CT多参数联合SD可提高诊断效能。Objective To evaluate the diagnostic value of multiple parameters derived from Dual-Layer Detector Spectral CT(DLSCT)in evaluating lymphatic metastasis(LM)in patients with rectal adenocarcinoma.Methods The data of 78 patients with rectal adenocarcinoma who underwent plain and dual-phase contrastenhanced scans by DLSCT before surgery were analyzed.According to the pathological findings,a total of 108 lymph nodes were enrolled and assigned to lymphatic metastasis(LM)group(n=52)and non-lymphatic metastasis(NLM)group(n=56).The short diameter(SD),effective atomic number(Eff-Z)from plain scan,iodine con-centration(IC)from arterial phase(AP),and venous phase(VP)were measured independently by two radiologists.The border,shape and enhancement homogeneity of each lymph node were evaluated.The normalized iodine concentration(NIC)in AP and VP were calculated.The differences of SD,border,shape,enhancement homogeneity,Eff-Z,NICAP,and NICVP were compared between the two groups by two independent samples Mann-Whitney test or Chi-square test.The diagnostic efficiencies were analyzed by receiver operating characteristic curves(ROC).Results There were statistical differences in SD,border,shape,enhancement homogeneity,NICAP,and NICVP between LM and NLM group(all P≤0.001.However,there was no significant difference in Eff-Z between the two groups(P>0.05).The areas under the curve(AUC)of SD,border,shape,enhancement homogeneity,NICAP,and NICVP to assess LM were 0.810,0.648,0.630,0.637,0.806,and 0.722,respectively(all P≤0.05.The combination of the SD,NICAP and NICVP had the highest AUC value of 0.911,sensitivity of 80.77%,and specificity of 85.71%.Conclusion The NIC derived from DLSCT could significantly improve the diagnostic accuracy of LM of rectal adenocarcinoma.DLSCT parameters combined with SD are helpful to improve the diagnostic efficiency.

关 键 词：直肠腺癌 淋巴转移 光谱CT 碘浓度 有效原子序数 

分 类 号：R445.3[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]