能谱CT在不同分化胃癌转移性淋巴结定性诊断中的价值

The value of energy spectral CT in qualitative diagnosis of metastatic lymph nodes of different differentiated gastric cancers

目的探讨能谱CT在不同分化胃癌转移性淋巴结定性诊断中的价值。方法分析50例经胃镜病理证实的胃腺癌患者的能谱CT影像资料,测量胃周淋巴结动脉期及静脉期标化碘值,并与手术病理结果相比较。结果50例胃腺癌患者中,胃癌手术及病理证实伴淋巴结转移38例,无淋巴结转移12例。经病理结果确认转移淋巴结83个,其中高中分化腺癌转移性淋巴结34个,低分化腺癌转移性淋巴结49个,非转移淋巴结31个。通过利用标化碘值及能谱曲线,能谱CT诊断胃癌淋巴结转移的灵敏度为90.4%(75/83),特异度为87.1%(27/31),诊断符合率为89.5%(102/114)。高中分化胃腺癌转移性淋巴结与非转移淋巴结动脉期及静脉期标化碘值比较,差异均有统计学意义(P<0.05)。结论能谱CT对于不同分化胃癌淋巴结的定性诊断具有重要价值,能够为胃癌的临床诊断及治疗方案的选择提供帮助。

Objective To explore the value of energy spectral computed tomography(CT) in qualitative diagnosis of metastatic lymph nodes of different differentiated gastric cancers.Methods The energy spectral CT imaging data of 50 patients with gastric cancer confirmed by gastroscope pathological examination were analyzed. Normalized iodine concentrations(NIC) was measured in the arterial and venous phases of gastric lymph nodes, and compared with the results of surgical pathology.Results Among the 50 cases of gastric adenocarcinoma, 38 cases were proved to have lymph node metastasis by operation and pathology of gastric cancer, and 12 cases had no lymph node metastasis. There were 83 metastatic lymph nodes confirmed by pathology, including 34 metastatic lymph nodes of high and moderate differentiation adenocarcinoma, 49 metastatic lymph nodes of low differentiation adenocarcinoma and 31 non-metastatic lymph nodes. By using NIC and energy spectrum curve, the sensitivity of energy spectral CT in diagnosis of lymph node metastasis of gastric cancer was 90.4%(75/83), with a specificity of 87.1%(27/31), and the diagnostic coincidence rate was 89.5%(102/114). There were significant differences in the NIC between metastatic lymph nodes and non-metastatic lymph nodes in arterial and venous phases of highly and moderately differentiated gastric adenocarcinoma(P<0.05).Conclusion Energy spectral CT plays an important role in the qualitative diagnosis of lymph nodes of different differentiated gastric cancers, which can provide help for the clinical diagnosis and treatment of gastric cancer.