双能量CT碘定量参数预测卵巢癌隐匿性腹膜转移的可行性  

Feasibility of dual-energy CT iodine quantitative parameters in predicting occult peritoneal metastasis of ovarian cancer

作　　者：宋庆玲 刘爱连[1] 李烨[1] 刘架伸 董德硕 郝丽[2] 刘义军[1] SONG Qing-ling;LIU Ai-lian;LI Ye;LIU Jia-shen;DONG De-shuo;HAO Li;LIU Yi-jun(The First Affiliated Hospital of Dalian Medical University,Dalian Liaoning 11601l,China;Department of Radiology,Dalian Municipal Central Hospital,Dalian Liaoning 116033,China)

机构地区：[1]大连医科大学附属第一医院,辽宁大连116011 [2]大连市中心医院放射科,辽宁大连116033

出　　处：《中国临床医学影像杂志》2024年第12期871-876,共6页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨双能量CT碘定量参数预测卵巢癌隐匿性腹膜转移(Occult peritoneal metastasis,OPM)的可行性。资料与方法:回顾性分析术前行双能CT扫描的92例卵巢癌患者(OPM 19例、腹膜转移阴性(NPM)73例)的资料,收集患者CA125、HE4。两名观察者分别独立测量原发灶实性成分最大层面动脉期、静脉期和延迟期碘浓度(AP-IC、VP-IC、DP-IC),并计算标准化碘浓度(AP-NIC、VP-NIC、DP-NIC)。组内相关系数(ICC)用于比较两位观察者测量的一致性,采用秩和检验比较两组间临床及影像参数的差异,Logistic回归分析用于筛选独立危险因素并建立联合模型。采用曲线下面积(AUC)、敏感度和特异度评估单变量及联合模型的效能,DeLong检验用于比较AUC的差异。结果:两组患者间年龄、月经状态、CA19-9的差异无统计学意义(P>0.05),两组患者间病理分型、CA125和HE4具有显著差异(P<0.05),OPM患者CA125明显高于NPM患者(186.90 U/mL vs.67.09 U/mL,P=0.005),OPM患者HE4明显高于NPM患者(291.00 pmol/L vs.103.60 pmol/L,P=0.001)。所有影像参数值的一致性均较好(ICC>0.75)。OPM卵巢癌三期的IC、NIC均明显高于NPM卵巢癌(9.96 mg/mL vs.4.91 mg/mL,13.36 mg/mL vs.6.10 mg/mL,13.82 mg/mL vs.5.37 mg/mL,0.12 vs.0.06,0.46 vs.0.20,0.56 vs.0.30,所有P<0.05)。HE4与VP-NIC是预测OPM的独立危险因素。由HE4和VP-NIC组成的联合模型的AUC为0.812,与VP-NIC和HE4的AUC无明显差异(P>0.05),但联合模型的特异度较HE4明显提升(P<0.001)。结论:双能量CT碘定量参数为卵巢癌患者治疗前OPM预测提供了新的检查方法,联合HE4具有更特异的预测价值。Objective:To explore the feasibility of dual-energy CT iodine quantitative parameters in the evaluation of occult peritoneal metastasis(OPM)of ovarian cancer.Materials and Methods:The data of 92 patients with ovarian cancer(19cases of OPM and 73 cases of negative peritoneal metastasis)who underwent dual energy CT scanning before operation were analyzed retrospectively,and CA125 and HE4 were collected.Two observers independently measured iodine concentration in the enhanced arterial phase,venous phase and delayed phase(AP-IC,VP-IC,DP-IC)of the maximum solid components of the primary tumor,and calculated the normalized iodine concentrations(AP-NIC,VP-NIC,DP-NIC).Intra-class correlation coeffi-cient(ICC)was used to compare the consistency of all measurements obtained by the two observers.Rank sum test was used to compare the differences of clinical and imaging parameters between the two groups.Logistic regression analysis was used to screen for independent risk factors and establish a joint model.The area under the curve(AUC),sensitivity and specificity were used to evaluate the effectiveness of univariate and joint model,and the DeLong test was used to compare the AUC differences.Results:There was no statistically significant difference in age,menstrual status,and CA19-9 levels between the two groups of patients(P>0.05).However,there was a significant difference in pathological classification,CA125 and HE4 levels between the two groups of patients(P<0.05),the CA125 level in OPM patients was significantly higher than that in NPM patients(186.90 U/mL vs.67.09 U/mL,P=0.005),the HE4 of OPM patients was significantly higher than that of NPM patients(291.00 pmol/L vs.103.60 pmol/L,P=0.001).The consistency of all imaging parameter values was good(ICC>0.75).The enhanced IC and NIC of OPM ovarian cancer were significantly higher than those of NPM ovarian cancer(9.96 mg/mL vs.4.91 mg/mL,13.36 mg/mL vs.6.10 mg/mL,13.82 mg/mL vs.5.37 mg/mL,0.12 vs.0.06,0.46 vs.0.20,0.56 vs.0.30,all P<0.05).HE4 and VP-NIC were independent risk

关 键 词：卵巢肿瘤 肿瘤转移 体层摄影术 X线计算机 

分 类 号：R737.31[医药卫生—肿瘤] R814.42[医药卫生—临床医学]