多层螺旋CT灌注成像对胃癌血管通透性评估的价值

Value of multi-slice helical CT perfusion imaging in evaluating the vessel permeability of gastric carcinoma

目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)灌注成像对胃癌血管通透性评估的价值。方法:对30例活检证实的胃癌患者术前行多层螺旋CT灌注成像,扫描图像经ADW4.0工作站处理,计算得到胃癌组织的表面通透性(permeability surface,PS)值,并分析其与胃癌临床病理特征和CT征象(CT轴位图像上瘤周低密度带厚度、肿瘤最大径和厚度)的关系。结果:胃癌病灶的PS值与淋巴结转移、TNM分期、组织学类型和肿瘤最大径均密切相关(P均<0.05),而与浸润深度、远处转移、性别、患者年龄和肿瘤部位无关。同时,胃癌PS值与CT轴位图像上瘤周低密度带厚度(r=0.417,P<0.05)和肿瘤最大径(r=0.557,P<0.01)均呈线性相关,而与肿瘤厚度无关。受试者工作特征(ROC)分析显示,胃癌PS值对胃癌组织学类型(分化型/未分化型)和TNM分期(Ia^IIIa/IIIb^IV)判断的准确率均较高[ROC曲线下面积(Az)分别为0.79和0.78]。结论:多层螺旋CT灌注成像对胃癌血管通透性的评估具有较大的临床应用价值。

Objective： To investigate the value of multi - slice helical CT perfusion imaging in evaluating the vessel permeability of gastric carcinoma. Methods： Multi -slice helical CT （MSCT） perfusion imaging was preoperatively performed in 30 patients with gastric carcinoma proved by biopsy. The scanning images were processed in ADW 4.0 workstation. The PS （permeability surface） value of gastric carcinoma was calculated and the correlation between PS value and the clinicopathologic parameters and CT features （ thickness of peritumor low - density band, maximal diameter and thickness of tumor on axial CT image ） of gastric carcinoma were analyzed. Results： The PS value of gastric carcinoma was closely related to lymph node metastasis, TNM stage , histologic type, and the maximal diameter of tumor （P 〈0.05）. However, there was no significant correlation between the PS value and depth of invasion, distant metstasis, gender, age, and tumor location. In addition, a linear correlation between the PS value of gastric carcinoma and the thickness of peritumor low - density band （ r = 0. 417, P 〈 0.05 ） and the maximal diameter of tumor （r =0. 557 ,P 〈0.01 ） on axial CT image was determined by logistic regression. However, there was no significant correlation between the PS value and the thickness of tumor on axial CT image. Receiver operating characteristic （ROC） analysis showed that the accuracy of the PS value of gastric carcinoma in determining the histologic type （differentiated/undifferentiated） and TNM stage （Ⅰa -Ⅲa/Ⅲb -Ⅳ） of gastric carcinoma was relatively high [ area under ROC curve （Az） was 0.79 and 0.78, respectively ]. Conclusion ： The clinical value of multi - slice helical CT perfusion imaging in evaluating the vessel permeability of gastric carcinoma is relatively high.