能谱CT参数变化预测放射及化学治疗中晚期非小细胞肺癌效果  

Changes of energy spectrum CT parameters for predicting chemoradiotherapy effect of middle-late stage non-small cell lung cancer

作　　者：刘斌[1] 沈健 万立野[1] 方跃 张冠男[3] 刘莉[4] 杜智颖 LIU Bin;SHEN Jian;WAN Liye;FANG Yue;ZHANG Guannan;LIU Li;DU Zhiying(Department of Radiology,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Department of Neurology,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Department of Medical Oncology,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Central Laboratory,Affiliated Hospital of Chengde Medical University,Chengde 067000,China)

机构地区：[1]承德医学院附属医院放射科,河北承德067000 [2]承德医学院附属医院神经内科,河北承德067000 [3]承德医学院附属医院肿瘤内科,河北承德067000 [4]承德医学院附属医院中心实验室,河北承德067000

出　　处：《中国医学影像技术》2023年第9期1336-1340,共5页Chinese Journal of Medical Imaging Technology

基　　金：承德市科技计划自筹经费项目(202204A060)。

摘　　要：目的观察能谱CT参数变化预测放射及化学治疗(放化疗)用于中晚期非小细胞肺癌(NSCLC)效果的价值。方法前瞻性纳入119例中晚期NSCLC患者,根据放化疗3个周期后效果分为有效组(n=42)及无效组(n=77)。比较组间及组内各时间点能谱曲线斜率(k)、碘浓度(IC)及其降低值的差异,分析能谱CT参数与放化疗效果的关系;以多因素logistic回归分析筛选放化疗效果的预测因素,绘制受试者工作特征曲线,评估以放化疗后能谱CT参数降低值预测疗效的价值。结果治疗前组间能谱CT参数差异均无统计学意义(P均>0.05)。放化疗1个及3个周期后,有效组动脉期k_(40~70 keV)、动脉期k_(40~100 keV)、静脉期k_(40~70 keV)、动脉期IC及静脉期IC均低于无效组(P均<0.05)及自身治疗前(P均<0.05);其动脉期k_(40~70 keV)、动脉期k_(40~100 keV)、静脉期k_(40~70 keV)、动脉期IC及静脉期IC降低值则均高于无效组(P均<0.05),且各参数降低值均与放化疗效果呈正相关(r:0.584~0.846,P均<0.001)。3个周期后动脉期k_(40~70 keV)、动脉期k_(40~100 keV)、静脉期k_(40~70 keV)、动脉期IC及静脉期IC为疗效的独立预测因素(P均<0.05)。联合应用1个及3个周期后各能谱CT参数降低值预测放化疗效果的曲线下面积分别为0.930和0.942,均优于各单一参数(P均<0.05),应用3个周期优于1个周期(P<0.05)。结论能谱CT参数变化可预测放化疗用于中晚期NSCLC效果。Objective To explore the value of changes of energy spectrum CT parameters for predicting radiation and chemotherapy(chemoradiotherapy)effect of middle-late stage non-small cell lung cancer(NSCLC).Methods Totally 119 patients with middle-late stage NSCLC were prospectively enrolled and divided into effective group(n=42)and ineffective group(n=77)according to the outcome after 3 cycles of chemoradiotherapy.The slope of the energy spectrum curve(k),iodine concentration(IC)and the reduction values were compared between groups and among those before,after 1 and 3 cycles within groups.The relationships of energy spectrum CT parameters and chemoradiotherapy effect were analyzed,the factors for predicting chemoradiotherapy effect were screened using multivariate logistic regression analysis,and the value of the reduced values of energy spectrum CT parameters for predicting chemoradiotherapy effect after treatment were analyzed using receiver operating characteristic(ROC)curve.Results No significant different of energy spectrum CT parameters was found between groups before chemoradiotherapy(all P>0.05).After 1 and 3 cycles of chemoradiotherapy,in effective group,arterial k_(40—70 keV),arterial k _(40—100 keV),venous k_(40—70 keV),arterial IC and venous IC were lower than those in ineffective group and in itself before chemoradiotherapy(all P<0.05).The reductions of arterial k_(40—70 keV),arterial k _(40—100 keV),venous k_(40—70 keV),arterial IC and venous IC in effective group were higher than those in ineffective group after 1 and 3 cycles of chemoradiotherapy(all P<0.05),which were positively correlated with the effect of chemoradiotherapy(r:0.584—0.846,all P<0.001).Arterial k_(40—70 keV),arterial k _(40—100 keV),venous k_(40—70 keV),arterial IC and venous IC after 3 cycles of chemoradiotherapy were independent factors for predicting chemoradiotherapy effect(all P<0.05).The area under the curve for predicting chemoradiotherapy effect with combination of the reductions of each parameter after 1 and 3

关 键 词：肺肿瘤 体层摄影术 X线计算机 放射治疗 药物治疗 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]