低剂量CTC联合iDose^4迭代重组技术在结直肠癌术前TNM分期中的应用

Application of Low-Dose CTC Combined with iDose^4 Iterative Reconstruction in Preoperative TNM Staging of Colorectal Cancer

目的探讨低剂量CT结肠成像(CTC)联合高级迭代重组算法(iDose^4)技术在结直肠癌术前分期的临床应用价值。方法回顾性分析本院2017年1月至12月102例结直肠癌患者术前采用常规剂量CTC扫描及滤波反投影法(FBP)重组的CT扫描资料和术后病理资料,与2018年1月至12月102例结直肠癌患者术前采用低剂量CTC扫描及iDose^4技术重组的CT扫描资料和术后病理资料,由两名高年资放射科医师采用双盲法进行术前影像学分期,对两种扫描方法的术前TNM分期与术后病理结果进行比较;并记录每例患者接受CT扫描时的CT容积剂量指数(CTDIvol)、剂量长度乘积(DLP),并估算出有效辐射剂量(ED)进行对比。结果常规剂量和低剂量CTC扫描方法对结直肠癌术前TNM分期判断的总体准确率T分期为78.43%(80/102)和86.27%(88/102)、N分期为69.61%(71/102)和63.72%(65/102)、M分期均为97.05%(99/102);两种扫描方法对结直肠癌术前TNM分期诊断准确率的差异无统计学意义(均P>0.05)。低剂量组的辐射剂量比常规剂量组降低了约68.65%。结论低剂量CTC联合iDose^4技术对结直肠癌术前TNM分期与术后病理具有良好的相关性,既能明显降低患者接受的辐射剂量,又能很好地满足临床医师对结直肠癌的术前评估要求和手术方案的制定,具有较好的临床应用价值。

Objective To evaluate the clinical value of low-dose CT colonography(CTC)combined with iDose4 iterative reconstruction in preoperative staging of colorectal cancer.Methods A retrospective analysis was performed to the CT scan and pathological data of 102 patients with colorectal cancer reconstructed by routine dose CTC scan and filtered back projection(FBP)technique in 2017,and 102 patients with colorectal cancer were reconstructed by low-dose CTC scan and iDose 4 iterative reconstruction technique in 2018,all the findings were reviewed by two senior radiologists separately for preoperative imaging staging.The preoperative TNM staging of the two methods were compared with the postoperative pathological results.The CT dose index volume and dose length product of each patient at the time of the CT scan were recorded,and the effective dose was calculated for comparison.Results The overall accuracy of preoperative routine and low dose CT colonography in TNM staging of colorectal cancer were 78.43%(80/102)and 86.27%(88/102),69.61%(71/102)and 63.72%(65/102),M stages were 97.05%(99/102);There was no significant difference between the two methods in the accuracy of preoperative TNM staging(P<0.05).The radiation dose of CT colonography in the low dose group was about 68.65%lower than that in the conventional dose group.Conclusion Low-dose CTC combined with iDose4 iterative reconstruction technique has a good correlation between preoperative TNM staging and postoperative pathology of colorectal cancer,which can significantly reduce the radiation dose received by patients.It can also meet the needs of preoperative evaluation of colorectal cancer and the formulation of a surgical plan,which has a good clinical value.