CT能谱成像在食管鳞癌病理分级诊断中的应用价值

Clinical Value of Spectral CT imaging in Diagnosis of Pathological Grading of Squamous Cell Carcinoma

目的研究能谱CT成像在不同分化程度食管鳞癌鉴别诊断中的价值。方法回顾性分析59例行能谱CT增强扫描检查并随后接受手术证实的食管鳞癌患者,在动脉期测量能谱CT参数,包括碘浓度(IC)、水浓度(WC)、有效原子序数(Eff-Z)及能谱曲线斜率(λHU)。比较食管不同病理分级食管鳞癌各能谱参数有无差异,利用受试者工作特征(ROC)曲线计算能谱定量参数的诊断准确度。结果本研究参照术后病理结果分为三组:高分化组、中分化组及低分化组。随着病理分级的增加,动脉期病灶的IC、λHU及Eff-Z均逐渐增高,且差异均有统计学意义(P<0.05),而不同病理分级患者之间病灶的WC差异无统计学意义(P>0.05)。ROC曲线显示动脉期病灶的IC、λHU及Eff-Z对低分化与中高分化食管鳞癌的鉴别诊断具有一定的诊断效能。结论能谱CT多参数成像对不同分化程度食管鳞癌的鉴别诊断有一定价值。

Objective To study the value of spectral CT imaging in the differential diagnosis of esophageal squamous cell carcinoma with different degrees of differentiation.Methods A retrospective analysis of 59 patients with squamous cell carcinoma of the esophagus who underwent spectral CT enhanced scanning and subsequently underwent surgery was made,and then parameters including Iodine concentration(IC),water concentration(WC),effective atomic number(Eff-Z)and spectral curve slope(λHU)were measured with spectral imaging post-processing software during arterial phase(AP).To compare the difference of spectral CT parameters between esophageal squamous cell carcinoma of different pathological grades,and to draw ROC curves for the parameters with statistical significance.The area under curve(AUC)was used to measure their differential diagnostic efficacy.Results According to the pathological results after operation,this study was divided into three groups:highly differentiated group,moderately differentiated group and poorly differentiated group.With the increase of pathological grading,IC,Eff-Z andλHU of lesions in arterial phase increased gradually,and the difference was statistically significant(P<0.05),but there was no significant difference in WC value between patients with different pathological grading(P>0.05).ROC curve analysis showed that IC,Eff-Z andλHU in arterial phase were effective in differential diagnosis of poorly differentiated and non-poorly differentiated esophageal squamous cell carcinomas.Conclusion Spectral CT multi-parameter imaging is valuable in the differential diagnosis of esophageal squamous cell carcinoma with different degrees of differentiation.