碘基值定量分析初步判断食管鳞癌病理分级

Iodine concentration in preliminary analysis of pathological grading of esophageal squamous cell carcinoma

目的探讨碘基值定量分析在初步判断食管鳞癌(ESCC)病理分级中的价值。方法对45例经手术病理证实的ESCC患者采用GE宝石CT能谱成像(GSI)行CT增强扫描,利用GSI分析软件在碘-水基物质图上测量病灶、相同时相胸主动脉及左心房的碘基值(IC),并计算病灶与胸主动脉及左心房的碘基值比值(A1、A2),对不同部位(胸上段、胸中段、胸下段)、不同病理分级(高分化、中分化、低分化)的病灶IC值及A1、A2值进行统计学分析。结果胸上段病灶的IC值[(19.63±7.92)mg/ml]高于胸中段[(17.65±4.28)mg/ml]和胸下段[(11.16±4.35)mg/ml];上、中段病灶间IC值差异无统计学意义(P=0.72),A1、A2值差异无统计学意义(P均>0.05)。高分化ESCC的IC值[(24.18±4.65)mg/ml]明显高于中分化ESCC[(17.53±4.04)mg/ml]和低分化ESCC[(9.63±2.93)mg/ml],三者间的IC值、A1、A2值差异均有统计学意义(P<0.001)。结论碘-水基物质图上测定的IC值能反映不同病理组成物质的X线吸收系数,对ESCC的病理分级具有一定判断能力,对指导治疗及判断预后有一定临床价值。

Objective To observe the clinical value of Gemstone Spectral Imaging （GSI） in preliminary assessment of pathology grading of esophageal squamous cell carcinoma （ESCC）. Methods Totally 45 patients with histologically proved ESCC underwent enhanced scan with CT spectral imaging mode. Monochromatic images and iodine-water based material decomposion images were generated. Iodine concentration （IC） values of ROI of the lesion, thoracic aorta and left atrium on the same slice or phase were measured, and the ratio of lesions IC value with the thoracic aorta IC value （A1） and left atrium IC value （A2） were calculated respectively at the same time, and were compared among different section and pathology grading. Results IC value of lesions in upper section （mg/ml） were higher than that in middle section （mg/ml） and lower section （mg/ml）, but no significant difference of IC value was found of lesions between upper section and middle section （P=0.72）, nor of A1 and A2 （P〉0.05）. IC value of highly differentiated ESCC （mg/ml） was higher than that of the medium （mg/ml） and pour differentiated （mg/ml） ones. IC value, A1 and A2 of lesions among different pathological grading had statistically differences （all P〈0.001）. Conclusion IC value can reflect X-ray absorption coefficient of different pathological material and has certain value in guiding treatment, judging pathological grading and prognosis.