双能CT定量参数术前预测上皮性卵巢癌分型的价值研究  

Value of dual-energy CT quantitative parameters in preoperative prediction of epithelial ovarian cancer types

作　　者：董德硕 刘爱连[1] 宋庆玲 刘义军[1] DONG De-shuo;LIU Ai-lian;SONG Qing-ling;LIU Yi-jun(Department of Radiology,First Affiliated Hospital of Dalian Medical University,Dalian Liaoning 116011,China)

机构地区：[1]大连医科大学附属第一医院放射科,辽宁大连116011

出　　处：《中国临床医学影像杂志》2025年第2期121-126,136,共7页Journal of China Clinic Medical Imaging

摘　　要：目的:探索双能CT定量参数术前预测上皮性卵巢癌(EOC)分型的价值。资料与方法:回顾性分析术前行双能CT扫描的113例EOC(Ⅰ型35例,Ⅱ型78例)患者资料,记录临床特征及FIGO分期。两名观察者分别独立测量病灶实性成分三期40~70 keV(间隔10 keV)各单能量水平的CT值,并计算增强动脉期、静脉期和延迟期标准化碘浓度(AP-NIC、VP-NIC、DPNIC)、细胞外体积分数(ECV)。组内相关系数(ICC)用于比较两位观察者间的一致性。采用独立样本t检验或Mann-Whitney U检验比较上述参数在两组间的差异。采用Logistic多因素回归分析寻找独立风险预测因子。曲线下面积(AUC)、敏感度和特异度用于评估单变量及联合模型的诊断效能。DeLong检验用于对比单变量和联合模型的AUC差异。结果:Ⅱ型EOC组患者年龄明显大于Ⅰ型EOC组,CA125、HE4明显高于Ⅰ型EOC组,而CA199低于Ⅰ型EOC组(P<0.001)。大部分Ⅰ型EOC为FIGOⅠ~Ⅱ期,大部分Ⅱ型EOC为FIGOⅢ~Ⅳ期,两组间有显著统计学差异(P<0.001)。双能CT所有参数值观察者间一致性均较好(ICC>0.75)。Ⅱ型EOC组三期40~70 keV CT值(除AP-60 keV、AP-70 keV)、AP-NIC、VP-NIC、DP-NIC、ECV均明显大于Ⅰ型EOC组(P<0.05),而AP-60 keV、AP-70 keV在两组间无统计学差异。其中,年龄、VP-NIC为术前预测EOC分型的独立风险预测因子。年龄、VP-NIC及联合模型的AUC分别为0.759、0.788、0.862,联合模型的诊断效能较单一因素有差异并具有统计学意义(P<0.05)。结论:双能CT定量参数联合临床指标可以在术前无创预测EOC的分型,其中年龄、VP-NIC为独立风险预测因子,其对传统FIGO分期的信息进行了生物学特性方面的补充,两者联合有助于精准化、个体化治疗方案的制定。Objective:To explore the value of dual-energy CT quantitative parameters in preoperative prediction of epithelial ovarian cancer(EOC)types.Materials and Methods:The data of 113 patients with EOC(35 patients with typeⅠand 78 patients with typeⅡ)who underwent dual-energy CT scan before surgery were retrospectively analyzed.The clinical features and FIGO staging were recorded.CT values of individual energy levels of 40~70 keV(interval 10 keV)were measured independently by two observers,and standardized iodine concentrations(AP-NIC,VP-NIC,DP-NIC)and extracellular volume fraction(ECV)in enhanced arterial,venous and delayed phases were calculated.The intra-group correlation coefficient(ICC)was used to compare the agreement of two observers.Independent sample t test or Mann-Whitney U test were used to compare the above parameters between the two groups.Multivariate Logistic regression analysis was used to find independent risk predictors.Area under the curve(AUC),sensitivity,and specificity were used to evaluate the diagnostic efficacy of univariate and combined models.The DeLong test was used to compare AUC differences between univariate and federated models.Results:The age of patients in typeⅡEOC group was significantly higher than those in typeⅠEOC group,CA125 and HE4 were significantly higher than that in typeⅠEOC group,while CA199 was lower than that in typeⅠEOC group(P<0.001).Most patients with typeⅠEOC had FIGO stageⅠ~Ⅱ,and most patients with typeⅡEOC had FIGO stageⅢ~Ⅳ,with statistically significant differences between the two groups(P<0.001).All parameters of dual-energy CT had good interobserver consistency(ICC>0.75).The CT value of 40~70 keV(except AP-60 keV and AP-70 keV),AP-NIC,VP-NIC,DP-NIC and ECV in phaseⅢEOC group were significantly higher than those in typeⅠEOC group(P<0.05),while there was no statistical difference between AP-60 keV and AP-70 keV between the two groups.Age and VP-NIC were independent risk predictors for preoperative EOC classification.The AUC of age,VP-NIC a

关 键 词：卵巢肿瘤 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]