摘要
目的研究能谱CT成像（GSI）定量分析在评估结肠癌分化程度中的价值。资料与方法纳入经结肠镜或手术病理确诊为结肠癌的47例患者,按照病理将其分为中高分化组18例和低分化与未分化组29例。所有患者术前均行GSI双期增强扫描,获得动脉期和静脉期单能量图像,测量并比较两组病灶40～140 ke V不同单能量的CT值、碘浓度、标准化碘浓度比（NIC）及各期能谱曲线斜率。采用受试者操作特征（ROC）曲线计算各参数曲线下面积（AUC）,比较各参数评定直肠癌分化程度的最佳诊断阈值、AUC、敏感度、特异度及Youden指数,评估各项指标的诊断效能。结果高分化腺癌11例,中分化腺癌7例,低分化癌20例,未分化癌9例。两组动脉期碘浓度、NIC、能谱曲线斜率及70 ke V CT值差异均有统计学意义（P〈0.05）,而以上指标静脉期差异均无统计学意义（P〉0.05）。动脉期碘浓度、动脉期NIC、动脉期能谱曲线斜率、70 ke V时CT值的ROC AUC分别为0.854、0.747、0.753和0.701,当其诊断阈值分别设为〉1.13 mg/ml、〉0.13、〉1.61、〉53.11 HU时,其判定直肠癌分化程度的敏感度、特异度、Youden指数分别为81.8%、71.4%、0.53;77.3%、64.3%、0.42;69.2%、71.4%、0.40;64.7%、62.3%、0.26。结论结肠癌能谱CT多参数定量分析评估肿瘤组织学分化程度有一定的特异度和敏感度,动脉期碘浓度的诊断效能明显优于70 ke V（相当于常规CT扫描）。
Purpose To study the value of gemstone spectral CT imaging（GSI） in the quantitative analysis of colon cancer in different stages. Materials and Methods Fortyseven patients with colon cancer confirmed by radical colon endoscopy or surgical pathology were enrolled in the study. According to the pathological findings, they were divided into the highly and medium differentiated group（group A, n=18） and the poorly differentiated or undifferentiated group（group B, n=29）. All the patients were undertaken direct line GSI dual-phase enhanced scan, and the monoenergetic images in both artery and vein phases were obtained. Then the CT values, iodine concentration（IC）, normalized iodine concentration（NIC）, and slope of the spectrum of the lesions were calculated and compared between the two groups when the single energy ranged from 40 ke V to 140 ke V. The receiver operating characteristic（ROC） curve was drawn and the best testing threshold, area under ROC curve（AUC）, sensitivity, specificity and Youden index were compared according to the parameters measured to evaluate the diagnostic effectiveness index. Results There were 11 cases with highly differentiated adenocarcinoma, 7 with medium-differentiated adenocarcinoma, 20 with poorly differentiated adenocarcinoma and 9 with undifferentiated adenocarcinoma. In arterial phase, the differences of IC, NIC, spectrum slope and CT values at 70 ke V were all statistically significant between the two groups（P〈0.05）, whilst none of the parameters were statistically different in venous phase（P〈0.05）. In arterial phase, the ROC AUC of IC, NIC, spectrum slope and CT value at 70 ke V were 0.854, 0.747, 0.753 and 0.701, respectively. When its testing threshold were set at more than 1.13 mg/ml, 0.13, 1.61 and 53.11 HU, its sensitivity, specificity and Youden index to differentiate the stages of colorectal c a n c e r w e r e 8 1. 8 %, 7 1. 4 %, 0. 5 3; 7 7. 3 %, 6 4. 3 %, 0. 4 2; 6 9. 2 %, 7 1. 4 %, 0. 4 0; and 64.7%, 62.3%, 0.26, respectively. Concl
出处
《中国医学影像学杂志》
CSCD
北大核心
2016年第3期208-211,213,共5页
Chinese Journal of Medical Imaging
关键词
结肠肿瘤
体层摄影术
X线计算机
病理学
外科
Intestinal obstruction
Tomography
X-ray computed
Pathology
surgical
