双能量CT检查多参数成像预测胰腺导管腺癌病理学分级的应用价值  

Application value of dual-energy CT multi-parameter imaging in predicting the pathological grade of pancreatic ductal adenocarcinoma

作　　者：林桂涵 陈炜越 许彩如 应海峰 曹婧婧 毛卫波[1] 陈敏江[1] 夏水伟 卢陈英[1] 纪建松[1] Lin Guihan;Chen Weiyue;Xu Cairu;Ying Haifeng;Cao Jingjing;Mao Weibo;Chen Minjiang;Xia Shuiwei;Lu Chenying;Ji Jiansong(Department of Radiology,Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research in Zhejiang Province,The Fifth Affiliated Hospital of Wenzhou Medical University,Lishui 323000,China)

机构地区：[1]温州医科大学附属第五医院放射科,全省影像与介入医学重点实验室,丽水323000 [2]温州医科大学附属第五医院病理科,丽水323000

出　　处：《中华消化外科杂志》2025年第1期127-136,共10页Chinese Journal of Digestive Surgery

基　　金：浙江省医药卫生项目(2023KY425)。

摘　　要：目的探讨双能量CT检查多参数成像预测胰腺导管腺癌病理学分级的应用价值。方法采用回顾性队列研究方法。收集2017年1月至2023年8月温州医科大学附属第五医院收治的147例胰腺导管腺癌患者的临床病理资料;男102例,女45例;年龄为(59±10)岁。患者均行术前双能量CT检查和术后组织病理学检查。147例患者采用分层随机抽样法按7∶3分为训练集103例和测试集44例。训练集用于构建预测模型,测试集用于验证预测模型效能。观察指标:(1)影响训练集胰腺导管腺癌患者病理学分级的因素分析。(2)胰腺导管腺癌病理学分级联合预测模型的构建与评价。正态分布的计量资料组间比较采用独立样本t检验;偏态分布的计量资料组间比较采用Mann-WhitneyU检验。计数资料组间比较采用χ^(2)检验。单因素和多因素分析采用Logistic回归模型。模型的效能评估采用受试者工作特征(ROC)曲线分析,并计算曲线下面积(AUC)、准确度、灵敏度和特异度,使用Delong检验分析模型效能。Hosmer-Lemeshow检验校准曲线和决策曲线分别用于评价列线图的一致性和临床应用价值。结果(1)影响训练集胰腺导管腺癌患者病理学分级的因素分析。多因素分析结果显示:肿瘤囊变坏死、血管侵犯、静脉期标准化碘浓度(NIC)、静脉期有效原子序数(Zeff)、静脉期能谱曲线斜率(λHU)均是训练集胰腺导管腺癌患者病理学分级的独立影响因素(优势比=4.326、3.887、4.155、5.389、3.164,95%可信区间(CI)为1.167~16.033、1.111~13.592、1.707~10.113、1.284~22.613、1.247~8.028,P<0.05)。(2)胰腺导管腺癌病理学分级联合预测模型的构建与评价。根据多因素分析结果,纳入肿瘤囊变坏死、血管侵犯、静脉期NIC、静脉期Zeff和静脉期λHU构建临床-影像学联合预测模型列线图。训练集中联合预测模型AUC为0.938(95%CI为0.896~0.981)、准确度为87.38%、灵敏度为89.74%、Objective To investigate the application value of dual-energy computer tomo-graphy(CT)multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma(PDAC).Methods The retrospective cohort study was conducted.The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected.There were 102 males and 45 females,aged(59±10)years.All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination.The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3.The training set was used to construct the prediction model,and the test set was used to verify the effectiveness of prediction model.Observation indicators:(1)analysis of factors affecting the pathological grade of PDAC patients in the training set;(2)construction and evaluation of the fusion prediction model for pathological grade of PDAC.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test.Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test.Comparison of count data between groups was conducted using the chi-square test.Univariate and multivariate analyses were conducted using the Logistic regression model.The performance of the model was evaluated by receiver operating characteristic(ROC)curve,and the area under the curve(AUC),accuracy,sensitivity and specificity were calculated.The Delong test was used to analyze the effec-tiveness of model.The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram,respectively.Results(1)Analysis of factors affecting the pathological grade of PDAC patients in the training set.Results of multivariate analysis showed that tumor cystic necros

关 键 词：胰腺肿瘤 体层摄影术 X线计算机 双能量CT成像 病理学分级 诊断 

分 类 号：R735.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]