SDCT多参数成像在术前预测胃腺癌脉管浸润及神经浸润中的应用价值  

Application value of SDCT multi-parameter imaging in preoperative prediction of lymphovascular invasion and perineural invasion in gastric adenocarcinoma

作　　者：杨鹏程 杨正高 胡瑞 张艳利[2] 雷军强[2] Yang Pengcheng;Yang Zhenggao;Hu Rui;Zhang Yanli;Lei Junqiang(The First Clinical Medical School,Lanzhou University,Lanzhou 730000,China;Department of Radiology,Intelligent Imaging Medical Engineering Research Center of Gansu Province,Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province,Radiological Clinical Medicine Research Center of Gansu Province,The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院放射科,甘肃省智能影像医学工程研究中心,精准影像协同创新甘肃省国际科技合作基地,甘肃省放射影像医学临床医学研究中心,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2023年第4期20-25,共6页Journal of Lanzhou University（Medical Sciences）

基　　金：兰州市城关区科技计划资助项目(2020RCCX0053)。

摘　　要：目的研究双层探测器光谱计算机断层扫描(SDCT)多参数成像对胃腺癌脉管浸润(LVI)及神经浸润(PNI)的术前预测价值。方法回顾性分析63例接受SDCT增强检查且经术后病理证实为胃腺癌的患者,分为LVI(+)与LVI(-)组,PNI(+)与PNI(-)组,LVI/PNI(+)与LVI/PNI(-)组。在动脉期和静脉期测量原发肿瘤的碘浓度(IC),有效原子序数和40、120 keV的虚拟单能图像CT值,并计算标准化碘浓度(NIC),40~120 keV的能谱曲线斜率(K_(40~120 keV))。采用独立样本t检验或Mann-Whitney U检验及二元Logistic回归分析筛选LVI、PNI的影响因素并建立预测模型,采用受试者操作特征曲线评价各种参数的诊断效能。结果动脉期K_(40~120 keV)、有效原子序数及静脉期IC、NIC、K_(40~120 keV)、有效原子序数在LVI(+)与LVI(-)组及LVI/PNI(+)与LVI/PNI(-)组中差异有统计学意义(均P<0.05),静脉期IC、NIC、K_(40~120 keV)、有效原子序数在PNI(+)与PNI(-)组中差异有统计学意义(均P<0.05)。动静脉期联合参数模型在预测LVI(+)及LVI/PNI(+)时效能更好,曲线下面积分别为0.785、0.986,静脉期联合参数模型和静脉期NIC在预测PNI(+)时效能相同,曲线下面积均为0.802。结论SDCT部分参数有助于术前评估LVI、PNI时状态,动静脉期联合参数模型在预测神经脉管浸润时具有很好的诊断价值。Objective To evaluate the preoperative prediction of lymphovascular invasion(LVI)and perineural invasion(PNI)in gastric adenocarcinoma by the double-layer spectral detector CT(SDCT)multi-parameter imaging.Methods 63 patients with gastric adenocarcinoma were retrospectively analyzed who had undergone enhanced SDCT examination and were pathologically confirmed after operation.They were divided into LVI(+)and LVI(-)group,PNI(+)and PNI(-)group,LVI/PNI(+)and LVI/PNI(-)group.Iodine concentration(IC),effective atomic number and virtual mono-energy image CT values of 40 keV and 120 keV were measured at the arterial and venous stage of primary tumors,and standardized iodine concentration(NIC)and energy spectrum slope of K_(40~120 keV) were calculated.Independent sample t test or Mann-Whitney U test were used for continuous variables,and statistically significant differences were found in the tests(P<0.05)were analyzed by binary Logistic regression to build a joint model.Finally,the receiver operator of the characteristic curve was used to evaluate the diagnostic efficacy of various parameters.Results There were significant differences in the arterial stage K_(40~120 keV),effective atomic number and venous stage IC,NIC,K_(40~120 keV),effective atomic number in LVI(+)and LVI(-)groups and LVI/PNI(+)and LVI/PNI(-)groups(all P<0.05);there were significant differences in IC,NIC,K_(40~120 keV) and effective atomic number in the venous phase between PNI(+)and PNI(-)groups(P<0.05).The combined parameter model of the arteriovenous phase had better performance in predicting LVI(+)and LVI/PNI(+),with an area under the curve of 0.785 and 0.986,respectively.The combined parameter model of the venous phase and NIC of the venous phase had the same performance in predicting PNI(+),with an area under the curve values of 0.802.Conclusion Some parameters of SDCT are helpful to preoperative assessment of LVI,PNI status in patients with gastric adenocarcinoma,and the combined parameter model of arteriovenous phase has a good diagnostic value i

关 键 词：计算机断层扫描 定量参数 胃癌 脉管浸润 神经浸润 

分 类 号：R735.2[医药卫生—肿瘤]