能谱CT成像定性评估不同分化食管癌转移淋巴结的应用价值

Application value of the spectral CT imaging in the qualitative evaluation of metastatic lymph nodes of differently differentiated esophageal cancer

目的:探讨能谱CT成像在定性评估不同分化食管癌转移淋巴结中的应用价值。方法:回顾性分析48例经内镜病理证实的食管鳞癌病人,术前均接受能谱CT胸部平扫及双期增强扫描,测量纵隔内淋巴结短径、动脉期70 keV下的CT值(CT70 keV)、动脉期及静脉期碘浓度,计算标准化碘浓度,并且与手术后病理结果相比较。结果:48例食管鳞癌病人中,食管癌手术及病理证实伴淋巴结转移32例,无淋巴结转移16例。经术后病理结果确认转移淋巴结79枚,其中高、中、低分化鳞癌转移淋巴结分别为14枚、27枚和38枚;非转移性淋巴结32枚,能谱CT成像诊断淋巴结转移与手术后病理结果差异无统计学意义(P>0.05)。高中分化食管鳞癌转移性淋巴结短径、动脉期CT70 keV、动静脉期标准化碘浓度均高于非转移性淋巴结(P<0.05~P<0.01)。低分化食管鳞癌转移性淋巴结短径、动脉期CT70 keV、动静脉期NIC均高于非转移性淋巴结(P<0.05~P<0.01)。ROC曲线分析显示,动脉期CT70 keV、动脉期标准化碘浓度及能谱曲线斜率联合诊断食管癌转移淋巴结的敏感度和特异度分别为86.1%和87.5%。结论:CT能谱成像在定性评估不同分化食管癌淋巴结中具有重要价值,能够为食管癌的N分期、临床诊断及治疗方案的选择提供帮助。

Objective:To explore the application value of spectral CT imaging in the qualitative evaluation of metastatic lymph nodes of differently differentiated esophageal cancer.Methods:The clinical data of 48 patients with esophageal squamous cell carcinoma confirmed by endoscopic pathology were retrospectively analyzed.All cases were detected using spectral CT chest plain scan and dual-phase enhanced scan before surgery.The short diameter of mediastinal lymph nodes,CT value at 70 keV arterial and iodine concentration in arterial and venous phases were measured,the normalized iodine concentration was calculated,and which was compared with the postoperative pathological results.Results:Among the 48 patients with esophageal squamous cell carcinoma,32 cases with lymph node metastasis and 16 cases without lymph node metastasis were confirmed by operation and pathology.The postoperative pathological results showed that 79 metastatic lymph nodes were found(including 14 highly differentiated squamous cell carcinoma metastatic lymph nodes,27 moderately differentiated squamous cell carcinoma metastatic lymph nodes and 38 poorly differentiated squamous cell carcinoma metastatic lymph nodes),and there were 32 non-metastatic lymph nodes.There was no statistical significance in the diagnosis of lymph node metastasis between spectral CT imaging and pathological results after surgery(P>0.05).The short diameter,CT70 keV and arterial phase hormalized iodine concentration in highly and moderately differentiated esophageal squamous cell carcinoma metastatic lymph nodes were higher than those in non-metastatic lymph nodes(P<0.05 to P<0.01).The short diameter,CT70 keV and arterial phase hormalized iodine concentration in pooryly differentiated esophageal squamous cell carcinoma metastatic lymph nodes were higher than those in non-metastatic lymph nodes(P<0.05 to P<0.01).The ROC curve analysis showed that the sensitivity and specificity of the combined of CT70 keV,normalized iodine concentration and spectral curve slope in arterial phase in the diagnosis of metastatic lymph node of esophageal cancer were 86.1%and 87.5%,respectively.Conclusions:The spectral CT imaging has important value in qualitative valuating the lymph nodes of differently differentiated esophageal cancer.It is helpful for N staging,clinical diagnosis and choice of treatment option of esophageal cancer.