探讨CT纹理分析在结肠癌术前评估中的价值

The value of CT texture analysis in preoperative evaluation of colon cancer

目的:通过分析结肠癌原发灶计算机体层成像(computed tomography,CT)纹理特征参数与临床病理学特征的相关性,以及单个淋巴结CT纹理特征与其是否转移的相关性,探讨CT纹理分析在结肠癌术前评估中的价值。方法:收集2018年1月—2019年3月于四川大学华西医院住院治疗拟行结肠癌根治性手术的结肠癌患者63例。患者术前1周行全腹部增强CT扫描,术后离体标本标记后送检。参照病理学检查结果,根据大体类型、组织学分级、淋巴结转移、脉管癌栓、周围神经受侵、单个淋巴结转移对患者进行分组。通过纹理分析软件提取纹理特征参数共41个。对各分组标准下的每两组纹理参数进行统计学分析,使用受试者工作特征(receiver operating characteristic,ROC)曲线进行效能评价。结果:在63例结肠癌患者中,共标记匹配淋巴结101枚,转移淋巴结15枚,非转移淋巴结86枚。各组筛选出相关性参数:大体类型,最大强度(max intensity,P<0.05,AUC=0.717);组织学分级,高灰度行程强调(high grey level run emphasis,P<0.05,AUC=0.708);淋巴结转移,体素值和(voxel value sum,P<0.05,AUC=0.658);脉管癌栓,体积计数(volume count,P<0.05,AUC=0.717);原发灶纹理参数与结肠癌患者有无周围神经受侵无明显相关性(P>0.05);单个淋巴结转移,惯性(inertia,P<0.05,AUC=0.671)。结论:CT纹理分析对结肠癌患者术前评估病理学分型、肿瘤分化程度、淋巴结转移、脉管癌栓等具有一定参考价值,且对于区域单个淋巴结性质,纹理分析相关参数可提供一定参考。

Objective:To explore the value of computed tomography(CT)texture analysis in preoperative evaluation of colon cancer by analyzing the correlation between the CT texture characteristic parameters of primary cancer and clinicopathological characteristics,as well as the correlation analysis between the CT texture characteristics of individual lymph nodes and their metastasis.Methods:A total of 63 colon cancer patients were selected who were proposed radical surgery for colon cancer from January 2018 to March 2019 in West China Hospital of Sichuan University.All the patients underwent a full-abdomen CT scan one week before the operation,and the postoperative specimens were marked and sent for examination.According to the pathological results,the patients were grouped by the general type,histological grade,lymph node metastasis,intravascular emboli,perineural invasion,and single lymph node metastasis.A total of 41 texture feature parameters were extracted by texture analysis software.The texture parameters of each group were statistically analyzed,and the receiver operating characteristic(ROC)curve was used for performance evaluation.Results:There were a total of 101 labeled matching lymph nodes,15 metastatic lymph nodes,and 86 non-metastatic lymph nodes in the 63 colon cancer patients.Correlation parameters were screened out by each group:general type,max intensity(P<0.05,AUC=0.717);histological grading,high grey level run emphasis(P<0.05,AUC=0.708);lymph node metastasis, voxel value sum (P<0.05, AUC=0.658);intravascular emboli, volume count (P<0.05, AUC =0.717);there was noobvious correlation between the texture parameters of primary lesions and the perineural invasion (P>0.05);single lymph nodemetastasis, inertia (P<0.05, AUC=0.671). Conclusion: CT texture analysis has certain reference value for preoperative evaluationof pathological classification, tumor differentiation, lymph node metastasis, and intravascular emboli in patients with colon cancer.Especially for the nature of regional single lymph nodes, texture analysis related parameters can provide some reference value.