CT直方图分析在预测和评估结直肠癌肝转移化疗疗效中的应用研究

The Value of CT Histogram Analysis in Predicting and Evaluating Chemotherapeutic Efficacy of Colorectal Liver Metastasis

目的探讨治疗前基线CT平扫、动脉期、静脉期及延迟期图像的直方图分析预测评估结直肠癌肝转移(CRLM)化疗疗效的价值。方法选取22例CRLM患者。所有患者均接受至少两次常规腹部平扫加增强三期CT扫描,于化疗1个月内行CT基线扫描,化疗开始后2~3个月内行第2次扫描以评估疗效。对患者各期CT图像进行直方图分析,依据实体肿瘤疗效评价标准(RECIST)进行疗效评估,获得相应转移瘤的全容积直方图参数,比较非进展组与进展组患者治疗前后CT直方图参数的差异。结果22例患者中,有效组16例,无效组6例。除平扫(Percentile75、Percentile90和Skewness)、静脉期(Kurtosis)、延迟期(Skewness和Kurtosis)外,其余参数治疗前后均有统计学差异(P<0.05);且Mode(平扫第1次)、Min(动脉期第2次)和Min(延迟期第2次)可以区分非进展与进展组,其中Mode(平扫第1次)的准确度达到了72.7%,Min(动脉期第2次)的诊断效能AUC值最高,达到0.813。结论CT全容积直方图分析对CRLM患者化疗疗效具有一定预测和评估价值。

Objective To explore the value of histogram analysis of baseline CT plain scan,arterial phase,venous phase and delayed phase images in evaluating the efficacy of colorectal liver metastasis(CRLM)chemotherapy before treatment.Methods 22 patients with CRLM were involved.All patients underwent at least 2 routine abdominal plain and enhanced three-phase CT scans.CT baseline scans were performed within 1 month of chemotherapy,and the second scan was performed within 2 to 3 months after the start of chemotherapy to evaluate the efficacy.The CT images of each phase were analyzed by histogram analysis,and the curative effect was evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST).The corresponding parameters of full volume histogram of metastatic tumor were obtained,and the difference of those histogram parameters of non-progressive group and progressive group were compared before and after treatment.Results Among the 22 patients,16 were effective and 6 were invalid.Except for plain scan(Percentile 75,Percentile 90 and Skewness),venous phase(Kurtosis and Skewness)and delayed phase(Kurtosis),the other parameters were significantly different before and after treatment(P<0.05),and Mode(the first time of plain scan),Min(the second time of arterial phase)and Min(the second time of delayed phase)could distinguish non-progressive from progressive group.Among them,the AUC value of Min(the second time of arterial phase)was the highest,reaching 0.813,and the accuracy of Mode(the first time of plain scan)was 72.7%.Conclusion CT volume histogram analysis has certain prediction and evaluation value for chemotherapy efficacy of CRLM patients.