螺旋CT多参数测量对结直肠癌旁肿瘤沉积的诊断价值

Diagnostic value of spiral CT multi-parameter measurements on tumor deposition in colorectal cancer

目的:探讨MSCT多参数测量在结直肠癌旁肿瘤沉积(TD)中的诊断价值,筛选最佳诊断参数。方法:回顾性分析经病理证实且CT上可辨识的结直肠癌旁TD病灶30个及淋巴结转移病灶30个的术前全腹部MSCT图像。测量结直癌旁TD及转移性淋巴结的多项参数值,包括病灶的长径、短径、平均径、长短径比、平扫、动脉期及静脉期CT值。比较2组病灶间各项参数值的差异并分析其诊断效能。结果:TD组中病灶的长径、短径、最大径和长短径比分别为(1.29±0.40)、(1.17±0.37)和(1.23±0.39)cm及1.11±0.07,淋巴结转移组分别为(1.01±0.32)、(0.80±0.34)和(0.91±0.33)cm及1.32±0.22,两组间差异均有统计学意义(P<0.05);TD组中病灶的平扫CT值、动脉期强化值和静脉期强化值分别为(29.13±6.82)、(33.67±8.49)和(52.77±9.82)HU,均大于淋巴结转移组[分别为(15.03±3.47)、(18.07±5.64)和(40.67±7.85)HU],组间差异均有统计学意义(P<0.05)。TD组中病灶的长径、短径、平均径、长短径比、平扫CT值、动脉期强化值和静脉期强化值诊断TD的受试者工作特征曲线(ROC)的曲线下面积(AUC)均>0.722,其中以平扫CT值、动脉期强化值和长短径比的诊断效能为佳,其AUC分别为0.965、0.911和0.881,最佳诊断阈值分别为21和45HU及1.33,相应的诊断敏感度分别为86.67%、83.33%和76.67%,特异度分别为100%、93.33%和90.00%。结论:MSCT多参数测量对鉴别结直肠癌旁肿瘤沉积与转移性淋巴结有较大价值,其中以平扫CT值、动脉期CT强化值和长短径比值的诊断效能为佳。

Objective:To explore the application value of spiral CT multi-parameter measurements on tumor deposition(TD)of colorectal cancer,and to screen out optimal diagnostic parameters.Methods:Thirty TD lesions identifiable on CT images of pathologically confirmed colorectal can-cer,and 30 metastatic lymphopathy were retrospectively analyzed.All patients underwent whole abdominal spiral CT scan before surgery.Multiple parameters of colorectal cancer TD and metastatic lymph nodes were measured,including long diameter,short diameter,average diameter,ratio of long to short diameter,plain CT value,arterial phase CT value and venous phase CT value.The multi-parameters values of the two groups and their diagnostic efficacy were compared.Results:The long diameter,short diameter,average diameter of the lesions in the TD group[(1.29±0.40),(1.17±0.37)and(1.23±0.39)cm]were all higher than those in the lymph node metastasis group[(1.01±0.32),(0.80±0.34)and(0.91±0.33)cm],with the ratio of long and short diameter(1.11±0.07)smaller than that in the lymph node metastasis group(1.32±0.22).The plain CT value,arterial phase enhancement value,and venous phase enhancement value in the TD group[(29.13±6.82),(33.67±8.49)and(52.77±9.82)HU]were all higher than those in the lymph node metastasis group[(15.03±3.47),(18.07±5.64)and(40.67±7.85)HU,with statistically significant difference(P<0.05).The area under the curve(AUC)of receiver operating characteristic(ROC)of TD diagnosed by long diameter,short diameter,average diameter,long and short diameter ratio,plain CT value,arterial phase enhancement value,and venous phase enhancement value in the TD group were all>0.722.The diagnostic efficiency of plain CT scan,arterial phase enhancement value,and the ratio of long and short diameter demonstrated better performance,with AUC coming at 0.965,0.911 and 0.881,optimal cut-off point was>21HU,>45HU and<1.33,with sensitivity of 86.67%,83.33%and 76.67%,and specificity of 100%,93.33%and 90.00%,respectively.Conclusion:CT multi-parameters measurements are of great value in differential diagnosis of tumor deposition of colorectal cancer and metastatic lymphopathy.Plain CT value,arterial phase enhancement value,and the ratio of long and short diameter have better diagnostic efficiency.