双层探测器光谱CT定量参数在胃癌免疫治疗中的临床价值  

Exploring the clinical value of dual-layer detector spectral CT quantitative parameters in immunotherapyfor gastric cancer

作　　者：刘颖[1] 詹鹏超 邢静静 梁盼[1] 高剑波[1] 张永高[1] LIU Ying;ZHAN Peng-chao;XING Jing-jing(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射科,河南郑州450052

出　　处：《放射学实践》2024年第12期1631-1635,共5页Radiologic Practice

摘　　要：目的:探讨双层探测器光谱CT定量参数在指导胃癌免疫治疗方面的临床价值。方法:回顾性分析2021年10月-2023年9月在本院接受了一线化疗联合程序性死亡受体1(PD-1)抑制剂治疗的35例胃癌患者的临床及影像资料。采用改良实体瘤临床疗效评价标准(mRECIST)评价治疗反应,将完全缓解(CR)和部分缓解(PR)作为应答组,疾病稳定(SD)和疾病进展(PD)作为无应答组。所有患者均在治疗前两周内接受了光谱CT平扫及双期增强扫描,对比剂注射30 s、60 s后分别获得动脉期、静脉期图像。在后处理工作站上重建图像并测量肿瘤的各项定量参数值,包括动脉期和静脉期碘浓度(IC)、标准化碘浓度(nIC)和有效原子序数(Z_(eff))。采用独立样本t检验、Mann-Whitney U检验或Fis-her精确检验比较两组间临床特征及各项光谱CT参数值的差异,并采用受试者操作特征(ROC)曲线评价各参数预测免疫治疗应答的效能。结果:应答组的动脉期和静脉期IC、nIC及Z_(eff)值均显著低于无应答组(P<0.05)。静脉期nIC预测胃癌免疫治疗应答的ROC曲线下面积(AUC)值最高,为0.798(95%CI:0.650~0.945),以0.49为截断值时,符合率为71.4%,敏感度为85.7%,特异度为61.9%;动脉期nIC的AUC值次之,为0.787(95%CI:0.631~0.944),以0.16为截断值时,符合率为77.1%,敏感度为78.6%,特异度为76.2%。静脉期nIC和动脉期nIC的AUC的差异无统计学意义(Z=0.13,P=0.898)。结论:光谱CT动脉期和静脉期nIC对胃癌免疫治疗应答具有良好的预测效能,是潜在的反映免疫治疗疗效的标志物。Objective:To preliminarily explore the clinical value of quantitative parameters on dual-layer detector spectral CT in guiding immunotherapy for gastric cancer.Methods:The clinical and imaging data of 35 gastric cancer patients who underwent first-line chemotherapy combined with programmed death-1(PD-1)inhibitors in our hospital from October 2021 to September 2023 were retrospectively analyzed.Treatment responses were evaluated according to the modified response evaluation criteria in solid tumor(mRECIST)criteria,with complete response(CR)and partial response(PR)categorized as the responsive group,and stable disease(SD)and progression disease(PD)as the non-responsive group.All patients underwent plain scanning and dual-phase contrast-enhanced scanning at a spectral CT scanner within two weeks prior to treatment,with arterial phase and venous phase images obtained 30 seconds and 60 seconds after contrast injection,respectively.Quantitative parameters,including arterial and venous phase iodine concentration(IC),normalized iodine concentration(nIC),and Z-effective(Z_(eff)),were measured from reconstructed images on the post-processing workstation.Clinical features and spectral parameters were compared between the two groups using independent sample t-test,Mann-Whitney U-test,or Fisher's exact test.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of each parameter for immunotherapy response.Results:Arterial and venous phase IC,nIC,and Z_(eff) in the responsive group were significantly lower than those in the non-responsive group(all P<0.05).The venous phase nIC achieved the highest area under the ROC curve(AUC)value for predicting immunotherapy response in gastric cancer,with a value of 0.798(95%CI:0.650~0.945).Using a cutoff value of 0.49,the accuracy was 71.4%,sensitivity was 85.7%,and specificity was 61.9%.The AUC value of arterial phase nIC ranked second highest at 0.787(95%CI:0.631~0.944),with a cutoff value of 0.16.The corresponding accuracy was of 77.1%,sensitivity

关 键 词：胃肿瘤 免疫治疗 体层摄影术 X线计算机 光谱成像 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563.3[医药卫生—放射医学]