基于光谱CT细胞外容积及相对电子密度识别结肠癌侵及浆膜  

Extracellular volume and relative electron density based on spectral CT for identifying colon cancer invasion into serous membrane

作　　者：王艺洁 赵卫[1] 何波[1] 李亚敏[1] 杨亚英[1] WANG Yijie;ZHAO Wei;HE Bo;LI Yamin;YANG Yaying(Department of Medical Imaging,the First Affiliated Hospital of Kunming Medical University,Kunming 650031,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650031

出　　处：《中国医学影像技术》2024年第7期1047-1051,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察基于双层探测器光谱CT(DLCT)细胞外容积(ECV)及相对电子密度(RED)识别结肠癌侵及浆膜的价值。方法回顾性纳入62例经病理诊断且CT显示肠周脂肪间隙模糊的结肠癌患者,其中18例T4a期肿瘤侵及浆膜、44例T2~T3期未侵及浆膜层;分析40 keV单能级显示结肠癌最大层面动脉期、静脉期及延迟期DLCT图像,测量各期图像中荷瘤与非荷瘤肠周脂肪、腹主动脉、髂总或髂外动脉碘浓度(IC)及RED,计算各期标准化IC(NIC)、荷瘤与非荷瘤肠周RED之差(RED差值)及延迟期ECV。比较不同分期肿瘤各参数值,针对差异有统计学意义者绘制受试者工作特征曲线,计算曲线下面积(AUC),评价其识别T4a期结肠癌侵及浆膜的效能并进行比较。结果与T2~T3期结肠癌相比,T4a期结肠癌患者年龄<50岁及存在淋巴结转移者占比均较高(P均<0.05),而结肠癌在各期图像中的NIC和RED差值及延迟期ECV均较高(P均<0.05)。以动脉期、静脉期及延迟期NIC鉴别T2~T3期与T4a期结肠癌的AUC为0.868~0.902,各期图像NIC间AUC差异均无统计学意义(P均>0.05);以动脉期、静脉期及延迟期RED差值鉴别的AUC分别为0.848~0.903,其间RED差值差异亦无统计学意义(P均>0.05);以延迟期ECV鉴别的AUC为0.948,与延迟期NIC和RED差值、动脉期NIC及静脉期RED差值差异均无统计学意义(P均>0.05)。结论基于DLCT ECV及RED可鉴别结肠癌肠周脂肪间隙模糊时是否已侵及浆膜。Objective To observe the value of extracellular volume(ECV)and relative electron density(RED)based on dual-layer detector spectral CT(DLCT)for identifying colon cancer invasion into serous membrane.Methods Sixty-two patients with pathologically confirmed colon cancer with blurred pericolonic fat gap on CT images were retrospectively collected,including 18 cases of T4a stage tumors with serous membrane invasion and 44 cases of T2—T3 stage without serous membrane invasion.The arterial,venous and delayed phase DLCT images under 40 keV showing the largest diameter of colon cancers were analyzed.The iodine concentration(IC)and RED of the pericolonic fat around tumor-bearing and tumor-free intestines,as well as of the abdominal aorta or the common or external iliac artery were measured,while normalized IC(NIC)and difference of RED(RED diff)of pericolonic fat around tumor-bearing and tumor-free intestines in each phase and ECV in delayed phase were calculated.The above parameters were compared between tumors with different stages,and for those with significant differences,the receiver operating characteristic curves were drawn,and the areas under the curve(AUC)were calculated to evaluate and compare the efficacies for identifying invasion of serous membrane in T4a stage colon cancer.Results Compared with T2—T3 stage colon cancers,T4a stage colon cancers were found more often occurred in patients aged<50 with higher proportion of lymph node metastases(both P<0.05),also higher values of NIC and RED diff on images in different phases,as well as ECV in delayed phase images(all P<0.05).The AUC of arterial,venous and delayed phase NIC for differentiating T2—T3 and T4a stage colon cancers ranged from 0.868 to 0.902,while of RED diff ranged from 0.848 to 0.903,all without significant difference(all P>0.05).The AUC of delayed phase ECV was 0.948,not significant different with that of delayed phase NIC and RED diff,arterial phase NIC nor venous phase RED diff(all P>0.05).Conclusion Based on DLCT,ECV and RED could be used to

关 键 词：结肠肿瘤 肿瘤浸润 浆膜 体层摄影术 X线计算机 

分 类 号：R735.35[医药卫生—肿瘤] R445.3[医药卫生—临床医学]