探讨双源CT双能量多参数成像预测进展期胃腺癌短径≥0.6 cm淋巴结转移的价值  

Exploring the Value of Dual-Source CT Dual-Energy Multiparametric Imaging for Predicting Lymph Node Metastasis of Short Axis≥0.6 cm in Advanced Gastric Adenocarcinoma

作　　者：王燕 王楠 俞贤博 李扬[1] 刘晶[1] 杨丽[1] WANG Yan;WANG Nan;YU Xianbo(Department of CT/MRI,the fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei Province 050011,P.R.China)

机构地区：[1]河北医科大学第四医院CT/MRI科,石家庄050011 [2]河北大学临床医学院,保定071000 [3]西门子医疗系统有限公司,北京100102

出　　处：《临床放射学杂志》2024年第6期966-970,共5页Journal of Clinical Radiology

基　　金：河北省科技厅卫生健康创新专项项目(编号:22377789D)。

摘　　要：目的 基于临床、传统影像及双能量特征构建模型预测进展期胃腺癌短径≥0.6 cm淋巴结转移,探讨双能量成像对胃癌淋巴结定性诊断的价值。方法 回顾性分析接受胃癌根治手术的172例进展期胃腺癌患者资料。为最大程度保证影像与病理淋巴结的对应性,仅从36例pN3患者中选取转移组淋巴结(n=114),从26例pN0患者中选取非转移组淋巴结(n=65),入组淋巴结短径均≥0.6 cm。将两组淋巴结以7∶3的比例随机分配到训练集(n=125)和验证集(n=54)。评估术前双能量CT图像,记录患者性别、年龄、原发肿瘤影像特征(部位、生长方式、大小、临床T分期)、淋巴结影像特征(大小、位置、形态、密度、边缘、强化程度)及淋巴结双能量特征(能谱曲线斜率、碘浓度、标准化碘浓度、Overlay值、双能指数、双能比、电子云密度、有效原子序数、脂肪分数)。采用单变量和多变量Logistic回归分析,基于临床、传统影像特征构建传统模型,基于临床、传统影像及双能量特征构建组合模型。采用ROC曲线和DCA曲线评价两种模型诊断效能。结果 原发肿瘤部位、原发肿瘤最大径≥7.50 cm、淋巴结边缘是传统模型淋巴结转移的独立预测因素,其在训练集及验证集的AUC分别为0.854和0.793。原发肿瘤部位、原发肿瘤最大径≥7.50 cm、淋巴结边缘、淋巴结脂肪分数是组合模型淋巴结转移的独立预测因素,其在训练集及验证集的AUC分别为0.902和0.865,诊断效能优于传统模型(P<0.05)。组合模型DCA曲线基本在传统模型曲线之上,临床收益更好。结论 组合模型对进展期胃腺癌短径≥0.6 cm淋巴结转移具有较高诊断价值。Objective To predict short axis≥0.6cm lymph nodemetastasis in advanced gastric adenocarcinoma based on clinical,traditional imaging and dual-energy features,and to explore the value of dual-energy imaging for qualitative diagnosis of gastric adenocarcinoma lymph nodes.Methods Retrospective analysis of data of 172 patients with advanced gastric adenocarcinoma who underwent radical resectionin.To maximize the correspondence between imaging and pathological lymph nodes,the metastatic group lymph nodes were selected from 36 patients with pN3(n=114)and the non-metastatic group were selected from 26 patients with pN0(n=65),and the short axis of lymph nodes were at least 0.6 cm.The lymph nodes were randomly allocated into the training cohort(n=125)and validation cohort(n=54).The patients'gender,age,image features of primary tumor(location,borrmann classification,size,T-stage),image features of lymph nodes(size,location,shape,density,margin,degree of enhancement)and dual energy features of lymph nodes(λHU,IC,SIC,Overlay,DER,DEI,Rho,Zeff,fat fraction)were recorded by evaluating preoperative dual energy CT images.By using univariate and multivariate Logistic regression analysis,traditional model was constructed based on clinical and traditional imaging features,and combined model was constructed based on clinical,traditional imaging and dual energy features.Receiver operating characteristics(ROC)curves and decision curve analysis(DCA)curves were used to evaluate the diagnostic performance of the two models.Results Primary tumor location,primary tumor maximum diameter≥7.50 cm,and lymph node margin were independent risk factors of lymph nodes metastasis in the traditional model,with AUC of 0.854 and 0.793 in the training and validation cohort.Primary tumor location,primary tumor maximum diameter≥7.50 cm,lymph nodes margin and fat fraction were independent risk factors of lymph node metastasis in the combined model,with AUC of 0.902 and 0.865 in the training and validation cohort,and the diagnostic efficiency was bette

关 键 词：胃癌 淋巴结转移 双能量 计算机体层成像 脂肪分数 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]