双层探测器光谱CT对宫颈癌分期的临床应用价值  

Value of Dual Layer Spectral Detector CT in Clinical Staging of Cervical Cancer

作　　者：梁欢欢 田冰 乔英[2] LIANG Huanhuan;TIAN Bing;QIAO Ying(School of Medical Imaging,Shanxi Medical University,Taiyuan,Shanxi Province 030001,P.R.China)

机构地区：[1]山西医科大学医学影像学院,太原030001 [2]山西医科大学第一医院CT影像科,太原030001

出　　处：《临床放射学杂志》2024年第1期100-104,共5页Journal of Clinical Radiology

摘　　要：目的探讨双层光谱探测器CT能谱图像在宫颈癌检出与分期中的应用价值。方法搜集首诊宫颈癌患者48例,均行光谱CT和盆腔MRI检查,有完整组织病理学资料。由两名高年资影像学医师以双盲法分析光谱CT 40 keV及MRI图像,记录是否为阳性病灶,对阳性病灶多平面观察肿瘤部位、大小及范围,判断有无宫旁浸润、阴道浸润及淋巴结转移,并评价分期。采用χ^(2)检验分析比较上述各组参数之间的差异。选择动、静脉两期病灶强化最明显区,勾画病灶和髂动脉ROI,记录碘密度(IC),并计算标准化碘密度(NIC),采用独立样本t检验,比较宫颈癌早期(≤ⅡA期)和进展期(≥ⅡB期)之间两项定量参数的差异;绘制ROC曲线,分析IC、NIC诊断宫颈癌早期及进展期的效能。结果MRI、光谱CT对宫颈癌的检出率均高于常规CT,分别为91.67%(44/48)、81.25%(39/48)、60.42%(29/48),差异有统计学意义。光谱CT对宫颈癌ⅡB期及以上诊断符合率(100%)高于MRI(95.65%),差异无统计学意义。MRI对宫颈癌ⅠB1期及以下、ⅠB2~ⅡA期诊断符合率(80.00%、90.00%)高于光谱CT(20.00%、75.00%),差异无统计学意义。光谱CT诊断宫颈癌淋巴结转移的敏感度、特异度和准确度(90.00%、100%、94.87%)高于MRI(65.00%、87.50%、77.27%),差异有统计学意义。宫颈癌进展期动、静脉两期的IC、NIC均高于早期,动脉期IC、NIC差异均有统计学意义。ROC曲线显示,动脉期NIC诊断宫颈癌早期及进展期的曲线下面积为0.718(95%CI:0.552~0.850),高于动脉期IC的曲线下面积0.704(95%CI:0.536~0.839),差异无统计学意义(Z=0.382,P>0.05),动脉期NIC诊断效果较佳。结论光谱CT可优化显示宫颈癌病灶及其浸润范围,对评价淋巴结转移有优势,动脉期IC、NIC在宫颈癌早期与进展期鉴别中有一定的诊断价值。Objective To investigate the value of dual-layer spectral detector CT energy spectrum images in the detec-tion and staging of cervical cancer.Methods Forty-eight patients with first diagnosis of cervical cancer were collected,all of whom underwent spectral CT and pelvic magnetic resonance imaging with complete histopathological data.Spectral CT 40 keV and MRI images were analyzed by 2 senior imaging physicians in a double-blind method to record whether they were positive lesions,to observe tumor site,size and extent in multiple planes for positive lesions,to determine the presence of pa-rametrial infiltration,vaginal infiltration and lymph node metastasis,and to evaluate the staging.Theχ^(2)test was used to an-alyze and compare the differences between the above-mentioned groups of parameters.The most obvious area of lesion in-tensification in both arterial and venous stages was selected,the ROI of lesion and iliac artery was outlined,iodine density(IC)was recorded,and standardized iodine density(NIC)was calculated,and the differences between the two quantitative parameters of early stage(≤stageⅡA)and progressive stage(≥stageⅡB)of cervical cancer were compared using in-dependent sample t-test.ROC curves were drawn to analyze the IC and NIC in diagnosing early stage and progressive stage of cervical cancer.The effectiveness of IC and NIC in diagnosing early stage and progressive stage of cervical cancer was analyzed.Results The detection rates of MRI and spectral CT for cervical cancer were higher than those of conventional CT,with 91.67%(44/48),81.25%(39/48)and 60.42%(29/48),respectively,and the differences were statistically significant.The diagnostic compliance rate of spectral CT for cervical cancer stageⅡB and above(100.00%)was higher than that of MRI(95.65%),and the difference was not statistically significant.The diagnostic compliance rate of MRI for cervical cancer stageⅠB1 and below and stageⅠB2-ⅡA(80.00%and 90.00%)was higher than that of spectral CT(20.00%and 75.00%),and the difference wa

关 键 词：光谱CT 宫颈癌 碘密度图 癌症分期 

分 类 号：R737.33[医药卫生—肿瘤] R730.44[医药卫生—临床医学]