单源双能CT能谱成像定量参数预测胃癌高度微卫星不稳定状态的价值  

Quantitative parameters of single-source dual-energy CT spectral imaging in preoperative prediction of gastric cancer with high microsatellite instability

作　　者：胡文君 陈安良[1] 刘义军[1] 刘爱连[1] HU Wenjun;CHEN Anliang;LIU Yijun;LIU Ailian(Department of Radiology,First Affiliated Hospital of Dalian Medical University,Dalian 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：《中国中西医结合影像学杂志》2025年第2期137-144,共8页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:探讨单源双能CT能谱成像定量参数无创预测胃癌高度微卫星不稳定(MSI-H)状态的价值。方法:收集行双能CT增强扫描且术后病理证实为胃癌的患者123例,其中MSI-H组41例,微卫星稳定(MSS)/低度微卫星不稳定(MSI-L)组82例。测量病灶平扫及3期增强扫描40~70 keV单能量CT值、能谱曲线斜率(K_(40~70))、3期增强扫描碘浓度(IC)值、标准化碘浓度(NIC)值、平扫有效原子序数(Z_(eff))值。比较2组病灶各参数值的差异,采用logistic回归分析筛选预测胃癌MSI-H的独立影响因素。采用ROC曲线和DeLong检验比较各参数效能。结果:MSI-H组平扫40~60 keV CT值、Z_(eff)值及K_(40~70)值均大于MSS/MSI-L组;MSI-H组的3期增强扫描40~70 keV CT值、K_(40~70)值、IC值,静脉期及延迟期NIC值均小于MSS/MSI-L组(均P<0.05)。各参数预测胃癌MSI-H的AUC为0.612~0.723。logistic回归分析显示,平扫40 keV CT值、静脉期50 keV CT值为独立影响因素(均P<0.05),两者联合诊断效能(AUC=0.746)高于各参数单独诊断。结论:单源双能CT的多种参数能有效预测胃癌MSI-H,平扫40 keV CT值、静脉期50 keV CT值联合可提升诊断效能。Objective:To evaluate the utility of quantitative parameters derived from single-source dual-energy CT(DECT)for noninvasive prediction of high microsatellite instability(MSI-H)status in gastric cancer.Methods:This retrospective study enrolled 123 patients with gastric cancer who underwent preoperative contrast-enhanced DECT.All patients were stratified into MSI-H group(41 cases)and microsatellite stable/low microsatellite instability(MSS/MSI-L)group(82 cases).Spectral imaging parameters were analyzed,including virtual monochromatic image(VMI)CT values at 40—70 keV,spectral curve slope(K_(40-70)),iodine concentration(IC),normalized iodine concentration(NIC),and effective atomic number(Z_(eff))in plain scan and contrast enhancement.Intergroup differences were compared using independent t-tests.Logistic regression identified independent predictors,while ROC curves and DeLong tests assessed diagnostic performance.Results:The MSI-H group exhibited significantly higher CT values at 40—60 keV,Z_(eff),and K_(40-70) in plain scan compared to the MSS/MSI-L group(all P<0.05).Conversely,lower CT values at 40—70 keV,K_(40-70),IC in arterial,venous and delayed phases,and NIC in venous and delayed phases were observed in the MSI-H group(all P<0.05).The AUC values of the individual parameters for predicting MSI-H status ranged from 0.612 to 0.723.Logistic regression analysis identified CT value at 40 keV in plain scan and CT value at 50 keV in venous phase as independent predictors(both P<0.05),and their combination yielded superior diagnostic accuracy(AUC=0.746)compared to individual parameters.Conclusions:Quantitative spectral parameters from single-source DECT enable preoperative discrimination of MSI-H status in gastric cancer.The synergistic combination of CT value at 40 keV in plain scan and CT value at 50 keV in venous phase demonstrates enhanced diagnostic efficacy.

关 键 词：胃肿瘤 微卫星不稳定 体层摄影术 X线计算机 能谱成像 

分 类 号：R73[医药卫生—肿瘤]