双能量CT及中性粒细胞与淋巴细胞比值对胃印戒细胞癌与胃部分印戒细胞癌的诊断价值  

Diagnostic value of dual-energy CT and neutrophil lymphocyte ratio for signet ring cell carcinoma and mixed signet ring cell carcinoma of the stomach

作　　者：宋芹霞[1] 王祥发 胡汉金[1] 朱娟[1] 张亚铭[2] 陈峰 SONG Qinxia;WANG Xiangfa;HU Hanjin;ZHU Juan;ZHANG Yaming;CHEN Feng(Department of Medical Imaging,Anqing Municipal Hospital,Anqing,Anhui Province 246003,China;Department of Oncological Surgery,Anqing Municipal Hospital,Anqing,Anhui Province 246003,China;Department of Internal Medicine,Anqing Second People's Hospital,Anqing,Anhui Province 246004,China)

机构地区：[1]安庆市立医院医学影像科,安徽安庆246003 [2]安庆市立医院肿瘤外科,安徽安庆246003 [3]安庆市第二人民医院内科,安徽安庆246004

出　　处：《实用放射学杂志》2023年第8期1284-1288,共5页Journal of Practical Radiology

摘　　要：目的探讨双能量CT(DECT)定量参数及中性粒细胞与淋巴细胞比值(NLR)对胃印戒细胞癌(SRC)与胃部分印戒细胞癌(mixed-SRC)的鉴别诊断价值。方法分析105例胃腺癌患者的临床及影像资料,包括动脉期及静脉期的碘浓度(ICAP、ICVP)、标准化碘浓度(NICAP、NICVP)、能谱曲线斜率(kAP、kVP),分析以上参数在2组的差异,计算NLR,使用受试者工作特征(ROC)曲线评价各参数诊断效能。记录无进展生存期(PFS)。结果SRC组与mixed-SRC组的ICAP分别为2.28±0.13、1.70±0.60;ICVP分别为2.96±0.10、1.70±0.11;NICAP值分别为0.20±0.04、0.19±0.03;NICVP值分别为0.61±0.27、0.48±0.10;kAP分别为3.19±0.25、3.10±0.15;kVP分别为3.56±0.40、3.15±0.54;NLR分别为2.88±1.61、3.76±2.34。ICVP、NICVP、kVP及NLR差异有统计学意义(P<0.05)。ICVP、NICVP、kVP、NLR鉴别诊断SRC与mixed-SRC的曲线下面积(AUC)分别为0.883、0.714、0.730、0.609;静脉期参数联合后AUC为0.941,再联合NLR,AUC为0.952,敏感性91.7%,特异性86.7%。多因素分析发现,胃癌亚型、NICVP、kVP及NLR是影响患者PFS独立危险因素(P<0.05)。PFS在SRC与mixed-SRC分别为18.9个月、16.7个月。结论SRC与mixed-SRC的DECT定量参数(ICVP、NICVP、kVP)及NLR存在差异,利用DECT及NLR有助于SRC与mixed-SRC术前鉴别诊断并评估预后。Objective To investigate the diagnostic value of quantitative parameters of dual-energy computed tomography(DECT)and neutrophil lymphocyte ratio(NLR)in distinguishing gastric signet ring cell carcinoma(SRC)from mixed signet ring cell carcinoma(mixed-SRC).Methods The clinical and imaging data of 105 patients with gastric adenocarcinoma were analyzed.The iodine concentration in the arterial phase and venous phase(ICAp,ICvp),normalized iodine concentration(NICAp,NICvp)and the slope of energy spectrum curve(kAp,kvp)were measured respectively.The dfferences in ICAp,ICvp,NICAp,NICvp,kap and kvp between the two groups were anylyzed,and the NLR was calculated.The diagnostic efficacy of DECT parameters was evaluated by receiver operating characteristic(ROC)curve,and the progression free survival(PFS)was also recorded.Results The ICAp of SRC group and mixed-SRC group were 2.28±0.13 vs 1.70±0.60,ICvp were 2.96±0.10 vs 1.70±0.11,NICAp were 0.20±0.04 vs 0.19±0.03,NICvpwere0.61±0.27vs 0.48±0.10,kApwere3.19±0.25vs3.10±0.15,kyp were3.56±0.40vs3.15±0.54,and NLRwere 2.88±1.61 vs 3.76±2.34,respectively.There were significant differences in ICvp,NICvp,kvp,and NLR(P<0.05).The area under the curve(AUC)of ICvp,NICvp,kvp and NLR in the differential diagnosis of SRC and mixed-SRC were 0.883,0.714,0.730 and 0.609.When the parameters of venous phase were combined,the AUC was 0.941.When combined the NLR,the AUC was 0.952,with the sensitivity of 91.7%and the specificity of 86.7%.Multivariate analysis showed that gastric cancer subtype,NICvp,kvp and NLR were independent influencing factors of PFS in patients with gastric adenocarcinoma(P<0.05).The PFS were 18.9 snd 16.7 months in SRC and mixed-SRC.Conclusion DECT quantitative parameters(IC_(VP),NIC_(VP) and k_(VP))and NLR aredifferent between SRC and mixed-SRC.The DECT and NLR arehelpful for preoperativedifferential diagnosis of SRC and mixed-SRC,and alsocanevaluate the prognosis.

关 键 词：印戒细胞癌 中性粒细胞与淋巴细胞比值 双能量CT 碘浓度 预后 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]