光谱CT多参数成像术前预测结肠癌神经及脉管侵犯状态的价值  

The value of spectral CT multi-parameter imaging in preoperative prediction of perineural and lymphovascular invasion in colon cancer

作　　者：刘思佳 赵卫[1] 胡继红[1] 李青青[1] 杨亚英[1] LIU Si-jia;ZHAO Wei;HU Ji-hong(Department of Radiology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,昆明650032

出　　处：《放射学实践》2024年第1期83-89,共7页Radiologic Practice

基　　金：云南省放射与治疗临床医学研究中心专项基金子课题(202102AA100067);昆明医科大学研究生创新基金项目(2022S230)。

摘　　要：目的:探讨光谱CT多参数成像术前预测结肠癌神经侵犯(PNI)及脉管侵犯(LVI)状态的价值。方法:搜集2021年9月至2022年9月在昆明医科大学第一附属医院行光谱CT扫描并经术后病理确诊为结肠癌的64例患者的临床及影像资料,根据术后病理中PNI/LVI的状态分为阳性组(29例)和阴性组(35例)。测量光谱CT动脉期、静脉期40 keV、90 keV单能级图像上病灶的CT值(CT40keV、CT90keV)、碘浓度(IC)、标准化碘浓度(NIC)、有效原子序数(Zeff)及标准化有效原子序数(NZeff),并计算光谱曲线斜率λ。比较两组间各光谱参数的差异,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)、敏感度、特异度及最佳阈值,以评估各参数的预测效能。结果:结肠癌PNI/LVI阳性组的动脉期和静脉期光谱CT定量参数CT40keV、IC、NIC、Zeff、NZeff及λ均高于阴性组,差异均有统计学意义(P均<0.05),而两组间动脉期和静脉期的CT90keV差异无统计学意义(P均>0.05)。ROC曲线分析结果显示,动脉期各参数预测结肠癌PNI/LVI状态的效能高于静脉期,其中以动脉期IC的预测效能最佳,其AUC值、敏感度和特异度分别为0.783(95%CI:0.672~0.894)、82.76%和65.71%。结论:光谱CT定量参数CT40keV、IC、NIC、Zeff、NZeff及λ在术前预测结肠癌PNI/LVI状态中具有一定价值,以动脉期IC的预测效能最佳。Objective:To investigate the value of spectral CT multi-parameter imaging in preoperative prediction of perineural and lymphovascular invasion in colon cancer.This study aims to investigate the value of spectral CT multi-parameter imaging in preoperative prediction of perineural and lymphovascular invasion(PNI/LVI)in colon cancer.Methods:The clinical and imaging data of 64 colon cancer patients confirmed by pathology in the First Affiliated Hospital of Kunming Medical University from September 2021 to September 2022 were collected.According to the presence of PNI/LVI,these patients were divided into the positive group(29 cases)and the negative group(35 cases).The CT values of 40keV and 90keV(CT 40keV,CT 90keV),iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number(Z eff),and normalized effective atomic number(NZ eff)were measured in the arterial and venous phases on spectral CT images,then the spectrum curve slopeλwas calculated.The difference of each spectral parameter between the two groups was compared,and the ROC curve with the area under the curve(AUC),sensitivity,specificity,and the optimal threshold were calculated to evaluate the predictive performance of each parameter.Results:Compared to the PNI/LVI-negative group,the PNI/LVI-positive group had higher CT 40keV,IC,NIC,Z eff,NZ eff,andλvalues on arterial and venous phases(all P<0.05).There was no significant difference in CT 90keV between the two groups in both phases(all P>0.05).The ROC curve showed that the predictive efficacy of each parameter in the arterial phase was higher than that in the venous phase,and the IC in the arterial phase had the highest predictive value in predicting PNI/LVI,with an AUC of 0.783(95%CI:0.672~0.894),sensitivity and specificity of 82.76%and 65.71%,respectively.Conclusion:The quantitative parameters of CT 40keV,IC,NIC,Z eff,NZ eff andλvalues on spectral CT have certain value in predicting preoperative PNI/LVI status of colon cancer,and the IC in arterial phase has the best predictive effic

关 键 词：结肠肿瘤 体层摄影术 X线计算机 神经侵犯 脉管侵犯 

分 类 号：R735.3[医药卫生—肿瘤] R814.42[医药卫生—临床医学]