应用640层动态能谱CT成像对结直肠肿物的初步研究

Preliminary study of colorectal mass using dynamic energy spectrum CT imaging

目的:评估动态能谱CT成像定量参数对结直肠癌分化程度及与结直肠良恶性肿物鉴别的诊断价值。方法:收集84例结直肠肿物患者行术前一站式动态能谱扫描,同时获得能谱及灌注成像数据。根据手术后病理学检查结果分为A组(腺瘤,n=15),B组(腺癌,n=69),再根据其分化程度将腺癌组分为B1组(高分化腺癌,n=36)和B2组(中低分化腺癌,n=33)。将不同组间的一般资料、病灶碘值(iodine value,IC)、标准化碘值(normalized iodine value,NIC)、动脉血流量(arterial blood flow,AF)、血容量(blood volume,BV)、表面渗透性(surface permeability,PS)进行统计学分析,受试者工作特征(receiver operating characteristic,ROC)曲线用于评估其诊断效能。结果:静脉期IC和NIC及AF、BV、PS对鉴别腺瘤和腺癌差异有统计学意义(P<0.005)。ROC曲线分析显示,静脉期NIC为3.52时鉴别腺癌与腺瘤的灵敏度72.0%、91.9%,AF值为175.13 mL/(min·100 g)时鉴别腺癌和腺瘤的灵敏度特异度分别为80.0%、86.4%;高分化腺癌和中低分化腺癌之间的AF、BV和PS差异均有统计学意义(P<0.001)。BV值为7.76 mL/100 g时鉴别高分化腺癌和中低分化腺癌的灵敏度、特异度分别为90.9%、77.7%。结论:一站式动态能谱CT扫描能同时得到能谱参数及灌注参数对鉴别结直肠良恶性肿物及肿瘤的分化程度有重要诊断价值。

Objective:To evaluate the diagnostic value of dynamic energy spectrum CT imaging quantitative parameters for the degree of colorectal cancer and the differentiation of benign and malignant colorectal tumors.Methods:Eighty-four colorectal tumor patients underwent one-stop dynamic energy spectrum scanning and obtained energy spectrum and perfusion imaging data.According to the pathology after the surgery,patients were divided into group A(adenomas,n=15)and group B(adenocarcinoma,n=69).According to the degree of differentiation,the adenocarcinoma components were group B1(highly differentiated adenocarcinoma,n=36)and group B2(poorly differentiated or undifferentiated adenocarcinoma,n=33).Statistical analysis of general data,lesion iodine value(IC),normalized iodine value(NIC),arterial blood flow(AF),blood volume(BV),and surface permeability(PS)between different groups,was carried.And receiver operating characteristic(ROC)curves were used to evaluate their diagnostic efficacies.Results:There was significant difference for IC,NIC,AF,BV,PS between the adenomas and the adenocarcinoma groups in portal venous phase(PP)(P<0.001).ROC curve analysis indicated that NIC of 3.52 in PP provided 72.0%sensitivity and 91.9%specificity in adenomas group from adenocarcinoma group.ROC curve analysis indicated that AF of 175.13 mL/(min·100 g)provided 80.0%sensitivity and 86.4%specificity in the adenomas from adenocarcinoma groups.There was no significant difference for IC and NIC between the well-differentiated and poorly differentiated or undifferentiated carcinoma in both AP and PP(P>0.005).There was significant difference for AF,BV and PS between well-differentiated and poorly differentiated or undifferentiated carcinoma(P<0.01).ROC curve analysis indicated that BV of 7.76 mL/100 g provided 90.9%sensitivity and 77.7%specificity in differentiating low grade cancer from high grade cancer.Conclusion:One-stop dynamic energy spectrum CT scan can obtain the spectral parameters and perfusion parameters at the same time and provide useful information to differentiate the benign and malignant colorectal tumors and low-grade colorectal cancer from high grade colorectal cancer in which to providing the greatest diagnostic value.