宝石能谱CT成像在乳腺浸润性导管癌淋巴结转移及血供情况的应用

Application of Gemstone Spectral Imaging in the Diagnosis of Lymph Nodes Metastasis and Blood Supply in Patients with Breast Infiltrating Ductal Carcinoma

目的研究宝石能谱CT成像(GSI)在乳腺浸润性导管癌淋巴结转移及血供情况的应用情况。方法选取2016年1月至2018年8月我院乳甲外科收治的63例经病理确诊的乳腺浸润性导管癌患者作为研究对象,术中均进行腋窝淋巴结清扫术,根据腋窝淋巴结转移情况分为转移组(42枚)和非转移组(98枚)。入选患者均采用GSI扫描,采用ADW4.6工作站及GSI-view软件进行处理,观察软件自动生成的KeVCT值曲线,记录淋巴结碘基值、CT值以及同层面的主动脉碘基值、CT值等,数据采用SPSS22.0统计学软件处理。结果 40-70KeV区间,转移组KeV-CT值斜率平均值(3.65±0.52),非转移组KeV-CT值斜率平均值(4.98±1.28),转移组淋巴结的KeV-CT值斜率明显低于非转移组,且差异具有统计学意义(P=0.03),70KeV以上区间斜率逐渐趋于水平。转移组淋巴结KeV斜率、碘基值、标准化碘基值均显著低于非转移组,且差异均具有统计学意义(P<0.01)。在不同KeV下转移组和非转移组淋巴结标准化CT值比较,差异均无统计学意义(P>0.05)。KeV-CT值斜率ROC曲线下AUC=0.801,碘基值AUC=0.779,标准化碘基值AUC=0.884,标准化碘基值诊断率最高。病灶血供显示较清晰。结论宝石能谱CT成像可作为乳腺浸润性导管癌的无创检查手段,对淋巴结转移及血供情况具有重要临床价值。

Objective To investigate the application of gemstone spectral imaging(GSI)in the diagnosis of lymph nodes metastasis and blood supply in patients with breast infiltrating ductal carcinoma.Methods 63 patients with pathologically confirmed breast infiltrating ductal carcinoma admitted to our hospital from January 2016 to August 2018 were selected as subjects.All patients underwent axillary lymph node dissection,and the nodes were divided into metastasis group(n=42)and non-metastasis group(n=98)according to axillary lymph node metastasis.All cases underwent GSI scan,and the images were retrospectively analyzed using GSI viewer on ADW 4.6 work station.The KeV-CT value curve was generated by the computer automatically,the iodine-based value and CT value of each lymph node and the corresponding strata of the artery were recorded.Then the SPSS22.0 software was used for statistical analysis.Results In 40-70 KeV area,the slope of KeV-CT value curve of metastasis group was significantly lower than that of non-metastasis group[(3.65±0.52)vs(4.98±1.28),P=0.13],and the curve was flattened above the 70 KeV area.The slope of KeV-CT value curve,Iodine-based value and the normalized Iodine-based value of metastasis group were significantly lower than those of non-metastasis group(P<0.01),while no statistical difference was found of the normalized CT value between groups(P >0.05).The areas under the ROC curve(AUC)of slope of KeV-CT value curve,Iodine-based value and the normalized Iodine-based value were 0.801,0.779 and 0.884,respectively,indicating that the normalized Iodine-based value had the highest diagnosis rate.The blood supply of lesions was clearly displayed.Conclusion GSI as a non-invasive examination is worthy of promotion in the detection of lymph nodes metastasis and blood supply in patients with breast infiltrating ductal carcinoma.