基于能谱CT多参数成像术前预测胃癌淋巴结转移的价值  

Preoperative Prediction Value of Energy Spectrum CT-based Multi-parameterImaging in Lymph Node Metastasis of Gastric Carcinoma

作　　者：徐敏 陈宏志 于娟 单丹丹 陈艾琪 马宜传 XU Min;CHEN Hong-zhi;YU Juan;DAN Dan-dan;CHEN Ai-qi;MA Yi-chuan(Department of Radiology,The First Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui 233004,China;Teaching and Research Section of Medical Imaging Diagnostics,Bengbu Medical University,Bengbu,Anhui 233030,China)

机构地区：[1]蚌埠医科大学第一附属医院放射科,安徽蚌埠233004 [2]蚌埠医科大学医学影像诊断学教研室,安徽蚌埠233030

出　　处：《河北北方学院学报（自然科学版）》2024年第12期1-7,共7页Journal of Hebei North University:Natural Science Edition

基　　金：蚌埠医学院自然科学研究重点项目(No.2021byzd179)。

摘　　要：目的探讨基于能谱CT多参数成像术前预测胃癌淋巴结转移的价值。方法回顾性分析经手术病理证实的89例胃癌患者的临床病理资料及能谱CT资料,其中男65例,女24例;年龄40~84岁。以病理结果为金标准分为淋巴结转移组(n=61)和非转移组(n=28),测量并计算胃癌原发灶能谱CT定量参数。对临床病理特征及能谱参数进行单因素分析,将其中差异有统计学意义的相关影响因素纳入多因素Logistic回归分析,筛选出胃癌淋巴结转移的独立影响因素,构建联合预测模型,同时绘制列线图将预测模型进行可视化显示。采用受试者工作特征(ROC)曲线对预测模型进行诊断效能分析。结果单因素分析显示:肿瘤的分化程度(χ^(2)=14.161、P=0.001)、T分期(χ^(2)=18.310、P=0.000)、肿瘤厚径(t=3.542、P=0.001)、动脉期碘基值(t=2.590、P=0.011)、动脉期标准化碘基值(t=3.384、P=0.001)、静脉期碘基值(t=2.562、P=0.012)、静脉期标准化碘基值(t=2.900、P=0.005)是胃癌淋巴结转移的相关影响因素;多因素分析显示:肿瘤的分化程度、T分期和静脉期碘基值是胃癌淋巴结转移的独立影响因素(优势比分别为2.768、3.136、1.141,95%可信区间分别为1.018~7.529、1.582~6.219、1.028~1.267,P<0.05)。该联合预测模型ROC曲线分析的AUC为0.841,95%CI为(0.747,0.936),敏感性0.836,特异性0.786。结论基于能谱CT多参数成像构建的预测模型在术前对胃癌淋巴结转移预测有较高价值,可作为术前评估患者的重要手段。Objective To investigate the value of multi-parameter imaging based on energy spectrum CT in preoperative prediction of lymph node metastasis in gastric cancer.Methods The clinicopathological data and energy spectrum CT data of 89 patients with gastric cancer confirmed by operation and pathology were retrospectively analyzed,including 65 males and 24 females,ranging in age from 40 to 84 years,with an average of(63.83±10.26).The patients were divided into lymph node metastasis group(n=61)and non-lymph node metastasis group(n=28),and the quantitative parameters of energy spectrum CT of primary gastric cancer were measured and calculated.The clinicopathological features and energy spectrum parameters were analyzed by single factor analysis,relevant influencing factors with statistically significant differences were included in multivariate Logistic regression analysis.Screening the independent influencing factors of gastric cancer lymph node metastasis,and construct the joint prediction model,meanwhile the prediction model was visualized by drawing a column graph.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of the prediction model.Results Single factor analysis showed that:Tumor differentiation degree(χ^(2)=14.161,P=0.001),T stage(χ^(2)=18.310,P=0.000),tumor thickness-diameter(t=3.542,P=0.001),iodine concentration at arterial phase(t=2.590,P=0.011),normalised iodine concentration at arterial phase(t=3.384,P=0.001),iodine concentration at venous phase(t=2.562,P=0.012)and normalised iodine concentration at venous phase(t=2.900,P=0.005)were correlated to lymph node metastasis in gastric cancer.Multivariate analysis showed that:the degree of tumor differentiation,T stage and iodine concentration at venous phase were independent influencing factors for lymph node metastasis of gastric cancer(odds ratio is 2.768,3.136,1.141 respectively;95%confidence interval were 1.018-7.529,1.582-6.219,1.028-1.267 respectively,P<0.05).The AUC and 95%CI of ROC curve analysis of the combined

关 键 词：胃癌 淋巴结 能谱CT成像 列线图 

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