大肠癌原发灶标准化碘浓度在大肠癌伴同期远处转移预测中的应用价值

The application value of normalized iodine concentration in the primary lesion of colorectal cancer in predicting synchronous distant metastasis

目的:探讨双源CT双能量扫描中原发灶碘浓度(iodine concentration,IC)与标准化碘浓度(nornalized iodine concentration,NIC)与大肠癌是否伴同期远处转移的相关性,用以预测大肠癌是否伴同期远处转移并判断预后。方法:回顾性分析2016年7月至2016年10月在哈尔滨医科大学附属肿瘤医院行双源CT双能量扫描及三维重建的病例,所有病例均为术前未行放化疗并于检查后两周内手术且术后病理证实为结直肠癌的病例资料,其中影像学诊断为同期远处转移者15例为实验组,随机选取无远处转移者30例为对照组。分别测量每组动脉期病灶IC及NIC与静脉期病灶IC与NIC。采用SPS 19. 0软件行统计学分析,独立样本t检验验证其是否有统计学意义,进行Pearson相关性分析,并绘制ROC曲线。结果:所有结果中,实验组静脉期病灶NIC为0. 618±0. 129,对照组静脉期病灶NIC为0. 707±0. 138,差异有统计学意义(P <0. 05)。Pearson相关性分析显示,静脉期NIC与大肠癌是否伴同期远处转移呈负相关。ROC曲线下面积为0. 67。约登指数最大值为0. 361,当静脉期NIC=0. 583时诊断效能最佳,敏感性为0. 533,特异性为0. 172。结论:两组动脉期IC、NIC及静脉期IC差异无统计学意义,而静脉期NIC差异有统计学意义,与转移存在相关性。双源CT双能量扫描静脉期NIC可以辅助预测大肠癌是否同期远处转移,为临床制定个体化治疗方案提供帮助。

Objective： To investigate whether iodine concentration（ IC） and normalized iodine concentration（ NIC） in the dual-source dual-energy CT scanning of primary lesions are associated with synchronous distant metastasis of colorectal cancer,in order to predict the presence of synchronous distant metastasis and the prognosis.Methods： A retrospective analysis of cases that underwent dual-source dual-energy CT scanning and three-dimensional reconstruction from July 2016 to October 2016 at Harbin Medical University Cancer Hospital was conducted. No chemotherapy was conducted before surgery and the cases were confirmed colorectal cancer through postoperative pathology after two weeks. Among them,15 cases confirmed with synchronous distant metastasis through imaging diagnosis were selected as the experimental group,and 30 patients without distant metastasis were randomly selected as the control group. IC and NIC were measured respectively in the arterial and the venous phases in each group. SPSS19. 0 was used to analyze the statistical results. Independent sample t test was used to verify whether the results were statistically significant. The Pearson correlation analysis was conducted and the ROC curve was drawn. Results： Among all results,NIC in the venous phase of the experimental group was 0. 618 ± 0. 129,that of the control group was0. 707 ± 0. 138,and the difference was statistically significant（ P〈0. 05）. Pearson correlation analysis showed that NIC in the venous phase was negatively correlated with synchronous distant metastasis of colorectal cancer. The area under the ROC curve was 0. 67. The maximum value of Youden index was 0. 361. When NIC in the venous phase =0. 583,the diagnostic performance was the best,where the sensitivity was 0. 533 and the specificity was 0. 172. Conclusion： IC and NIC in the arterial phase and IC in the venous phase were not statistically significant between the two groups. NIC in the venous phase between the two groups was statistically significant and correlated with the metastasis. NIC in the venous phase by dual-source dual-energy CT scanning can help predict the synchronous distant metastasis of colorectal cancer,and provide reference for developing personalized treatment plans clinically.