摘要
目的应用双能量CT(DECT)分析确诊的食管癌患者转移性淋巴结及非转移性淋巴结之间的数据差异,探讨双能量成像在预测淋巴结转移的应用价值。方法回顾性收集经病理证实的食管癌患者80例,利用双能量后处理技术多材料分解算法获得碘图及脂肪图,纳入124个淋巴结(其中转移性淋巴结56个、非转移性淋巴结68个)测得碘含量(IC)、标准碘含量(NIC)及脂肪分类(FC)等数据,以病理作为分组金标准,对两组淋巴结进行量化分析,采用独立样本t检验评价各组数据之间的差异性,评估DECT碘图及脂肪图对食管癌淋巴结转移的诊断效能,得出曲线下面积(AUC)最大时各参数的阈值。前瞻性收集经活检确诊食管癌并拟治疗患者的100个未知纵隔淋巴结进行数据测定,按照回顾性研究中得出的各参数的阈值作为判定淋巴结转移的临界值,对该100个淋巴结进行预测并与病理结果作为对照,进行Kappa一致性检验。结果两组淋巴结动脉期碘含量(ICA)、静脉期碘含量(ICV)、静脉期标准碘化率(NICV)、动脉期脂肪分类(FCA)及静脉期脂肪分类(FCV)等存在统计学差异(P<0.05)。当阈值ICV 2.25 mg/mL、NICV 23.6%、ICA 2.51 mg/mL时,诊断转移性淋巴结AUC最大,分别为0.877、0.695、0.625;当阈值FCA 39.30%、FCV 38.65%时,诊断非转移性淋巴结AUC最大,分别为0.691、0.836。对100个未知纵隔淋巴结进行参数测量,当ICV大于2.25 mg/mL倾向为转移性淋巴结,计1分,否则计0分;NICV大于23.6%时,计1分,ICA大于2.51 mg/mL时,计1分;当FCA大于39.30%倾向为非转移性淋巴结,计0分,否则计1分;FCV大于38.65%时,计0分。最终五项总分达到3分时诊断为转移性淋巴结,诊断结果与病理结果检验Kappa值为0.762。结论当阈值ICV 2.25 mg/mL、NICV 23.6%、ICA 2.51 mg/mL时诊断转移性淋巴结效能最大,当阈值FCA 39.30%、FCV 38.65%时诊断非转移性淋巴结诊断效能最大,碘图联合脂肪图对食管癌淋巴�
Objective To explore the application of dual-energy computed tomography(DECT)iodine map and adipose map in the diagnosis of mediastinal lymph node metastasis of esophageal cancer.Methods Preoperative contrast-enhanced DECT of 80 patients with pathologically confirmed esophageal squamous cell carcinoma was post-processed to obtain the iodine and adipose maps.The iodine concentration(IC),normalized iodine concentration(NIC)and fat content(FC)were derived from these maps.124 mediastinal lymph nodes in these patients were divided into the metastatic(56)and benign(68)groups using pathological results as the gold standard.Independent sample t-test was used to evaluate differences of the IC,NIC and FC between the metastatic and benign lymph nodes.Diagnostic efficiency of each DECT-derived parameter for differentiating metastatic and benign lymph nodes was evaluated using receiver operating characteristic(ROC)curve and the optimal threshold with the maximum area under the ROC curve(AUC)was determined.A total of 100 mediastinal lymph nodes on DECT in patients with esophageal cancer were then evaluated prospectively.Kappa test was used to evaluate the consistency of DECT diagnosis and pathological findings in predicting lymph node metastasis.Results The IC in the venous phase(ICV),NIC in the venous phase(NICV),IC in the arterial phase(ICA),FC in the arterial phase(FCA),and FC in the venous phase(FCV)were significantly different in the 2 lymph node groups with optimal AUCs at threshold of ICV>2.25 mg/mL(AUC=0.877),NICV>23.6%(0.695),ICA>2.51 mg/mL(0.625),FCA<39.30%(0.691)and FCV<38.65%(0.836).The Kappa consistency test of preoperative diagnosis and pathological findings of 100 mediastinal lymph nodes from esophageal cancer was 0.762.Conclusion When ICV 2.25 mg/mL,NICV 23.6%,ICA 2.51 mg/mL,the area under the curve of metastatic lymph nodes was the largest,when FCA 39.30% and FCV 38.65% were the cut-off values,the area under the curve of diagnosed non-metastatic lymph nodes was the largest,DECT iodine and adipose maps have goo
作者
陈瑶
杜芳
翟润亚
江芳莲
CHEN Yao;DU Fang;ZHAI Runya;JIANG Fanglian(Department of Radiology,Affiliated Hospital of Yangzhou University,Jiangsu 225100,China)
出处
《影像诊断与介入放射学》
2023年第3期169-175,共7页
Diagnostic Imaging & Interventional Radiology
关键词
食管癌
淋巴结转移
碘图
脂肪图
双能量CT
Esophageal cancer
Lymph node metastasis
Iodine map
Adipose map
Dual-energy computed tomography
