CT能谱成像技术在评估结直肠癌病灶周围淋巴结术前转移的临床价值

Clinical Value of CT Energy Spectrum Imaging Technology on Evaluating Preoperative Lymph Node Metastasis around Colorectal Cancer Lesions

目的 探究CT能谱成像技术在评估结直肠癌(CRC)病灶周围淋巴结术前转移的临床价值。方法选取2021年5月至2023年5月于影像科进行CT检查且经病理证实的CRC患者104例,经检查共纳入131枚淋巴结,其中转移性淋巴结79枚,非转移性淋巴结52枚。利用CT能谱成像技术进行扫描分析,比较两种淋巴结短径、形态学差异、动脉期与静脉期碘浓度(IC)、标准化碘浓度(NIC)和斜率(λ_(HU))等能谱参数,绘制受试者工作特征(ROC)曲线评估CT能谱参数对淋巴结转移的诊断效能。结果CRC病灶周围转移性淋巴结的轴位短径、矢状位短径和冠状位短径均大于非转移性淋巴结(P<0.05);转移性淋巴结边缘模糊、有聚集和强化不均的占比均高于非转移性淋巴结(P<0.05);转移性淋巴结动脉期与静脉期IC、NIC和λ_(HU)均低于非转移性淋巴结(P<0.05);经ROC曲线分析,CT能谱成像参数对淋巴结转移诊断具有一定应用价值(P<0.05),动脉期IC、NIC及静脉期NIC诊断效能最高,AUC分别为0.894、0.895、0.892,敏感度分别为91.14%、86.08%、93.67%,特异度分别为73.08%、82.69%、76.92%。结论CT能谱成像可鉴别非转移性淋巴结与转移性淋巴结短径和形态学差异,CT能谱参数可较为准确地判断CRC患者病灶周围淋巴结术前转移情况。

Objective To explore the clinical value of CT energy spectrum imaging technology on the evaluation of preoperative lymph node metastasis around colorectal cancer(CRC) lesions.Methods 104 patients with CRC who underwent CT examination in imaging department and were confirmed by pathology were selected between May 2021 and May 2023.131 lymph nodes were included in the examination,including 79 metastatic lymph nodes and 52 non-metastatic lymph nodes.CT energy spectrum imaging technology was used for scanning analysis,and energy spectrum parameters such as short diameter,morphological difference,iodine concentration(IC),normalized iodine concentration(NIC) and slope(λ_(HU)) arterial phase and venous phase were compared between the two types of lymph nodes,and receiver operating characteristic(ROC) curve was drawn to evaluate the diagnostic efficiency of CT energy spectrum parameters on lymph node metastasis.Results The axial,sagittal and coronal short diameters of metastatic lymph nodes around CRC lesions were longer than those of non-metastatic lymph nodes(P<0.05).The proportions of blurred margin,aggregation and uneven enhancement of metastatic lymph nodes were higher than those of non-metastatic lymph nodes(P<0.05).The IC,NIC and A_(HU) of arterial phase and venous phase of metastatic lymph nodes were lower than those of non-metastatic lymph nodes(P<0.05).According to ROC curve analysis,CT energy spectrum imaging parameters had certain application value in the diagnosis of lymph node metastasis(P<0.05).The diagnostic efficiency of IC and NIC in arterial phase and NIC in venous phase was the highest,with AUCs of 0.894,0.895 and 0.892,sensitivities of 91.14%,86.08% and 93.67% and specificities of73.08%,82.69% and 76.92% respectively Conclusion CT energy spectrum imaging can distinguish the short diameter and morphological difference between non-metastatic lymph nodes and metastatic lymph nodes,and CT energy spectrum parameters can accurately judge the preoperative lymph node metastasis around lesions in patients wit h CRC.