单源双能CT碘定量分析技术鉴别不同病理级别膀胱尿路上皮癌的价值

Iodine quantitative analysis technology of single-source dual-energy CT:value of differential diagnosis for urothelial carcinoma of bladder with different pathological grades

目的:探讨单源双能CT碘定量测量对不同病理分级膀胱尿路上皮癌(UCB)的鉴别诊断价值。方法:回顾性分析经手术病理证实的41例单发UCB患者的病例资料,其中高级别(HG-UCB)25例,低级别(LG-UCB)16例。所有患者在术前采用单源双能CT能谱成像模式(GSI)进行盆腔三期动态增强扫描。应用GSI综合分析平台,生成动脉期和静脉期碘(水)浓度图。由两位观察者分别测量两组病灶在动脉期、静脉期图像上的碘(水)浓度值(IC),记为ROI T,同时测量髂总动脉的碘(水)浓度值,记为ROI A,并计算两期标准化碘水浓度值(NIC=ROI T/ROI A)。采用组内相关系数(ICC)分析两位观察者测量各期数据结果的一致性,采用独立样本t检验分析两组病灶在两期增强图像上的IC及NIC值的差异,采用ROC曲线分析有统计学差异参数的诊断效能。结果:两位观察者获得的各项数据一致性良好(ICC>0.9)。动脉期HG-UCB的IC(21.197±6.775)和NIC(0.196±0.044)值均显著高于LG-UCB(分别为16.144±7.923和0.142±0.054),差异均具有统计学意义(P<0.05);静脉期两组病灶的IC及NIC分别为22.082±5.395和20.124±4.932、0.582±0.149和0.546±0.182,差异均无统计学意义(P>0.05)。动脉期IC和NIC诊断HG-UCB的AUC分别为0.692、0.778,敏感度和特异度分别为88.0%和56.2%、92.0%和62.5%。结论:单源双能CT动脉期碘(水)浓度值和标准化碘(水)浓度值可鉴别不同病理级别膀胱尿路上皮癌,具有一定临床应用价值。

Objective:The purpose of this study was to investigate the differential diagnosis value of single-source dual-energy CT iodine content measurement in different pathological grades of urothelial Carcinoma of the Bladder(UCB).Methods:The clinical,pathological and imaging data of 41 patients with single nodule UCB confirmed by surgical pathology were retrospectively analyzed,including 25 cases of high grade(HG-UCB)and 16 cases of low grade(LG-UCB).All patients underwent pelvic spectral CT plain and three phases enhanced scan.The iodine(water)concentrations(IC)in the lesions that marked as ROIT(ROI of tumor),and the iodine(water)concentrations that marked as ROI A in the arteria iliaca communis of the arterial and venous phase were measured,and the normalized iodine(water)concentrations(NIC=ROI T/ROI A)value was calculated on a GSI comprehensive analysis platform by two observers.The intra-class correlation coefficient(ICC)was used to check the consistency of the data measured by the two observers.The above parameters between the two groups were compared by t-test,and the ROC curve was used to evaluate the diagnostic efficacy of these parameters.Results:The consistency of the data obtained by the two observers were good(ICC value>0.9).On the arterial phase,both the IC and NIC of HG-UCB(21.197±6.775 and 0.196±0.044,respectively)were significantly greater than those of LG-UCB(16.144±7.923 and 0.142±0.054,respectively)with statistical significance(P<0.05);and there were no statistical differences for parameters between the two groups on the venous phase(P>0.05).The area under the curve(AUC)value of IC and the NIC on the arterial phase for differentiating the different grades tumor was 0.692 and 0.778 respectively,which yielded sensitivity and specificity of 88.0%and 56.2,92.0%and 62.5%,respectively.Conclusion:The iodine concentration and normalized iodine concentration on the arterial phase of single-source dual-energy CT can be quantitatively identified for different pathological grades of urothelial carcinoma of the bladder with certain application value.