CT能谱成像术前评估食管胃结合部腺癌病理分级诊断价值

Value of spectral CT imaging in the preoperative evaluation of pathological grades of esophagogastric junction adenocarcinoma

目的探讨CT能谱成像定量参数术前评估食管胃结合部腺癌病理分级的诊断价值。方法前瞻性分析经内镜证实为食管胃结合部腺癌,且行手术治疗最终获得病理结果的59例患者的临床和影像资料。所有患者术前1周内行常规胸腹部平扫和能谱成像双期增强扫描,测量并计算病灶强化值(Hu)、标准化碘浓度(NIC)、标准化有效原子序数(Zeff-a)及能谱曲线斜率(λHu)。采用Kruskal-Wallis检验、单因素方差分析比较不同病理分级、不同T分期间各参数值的差异,受试者工作特征曲线(ROC)曲线用于评价各参数值诊断低分化食管胃结合部腺癌的效能。结果不同病理分级间动脉期及静脉期NIC、λHu、Zeff-a和Hu值的差异均有统计学意义(均P<0.05),且各参数与肿瘤病理分级呈正相关(P<0.01)。动脉期NIC诊断低分化食管胃结合部腺癌的效能最高,ROC曲线下面积(AUC)0.961,阈值0.125,敏感度95.8%,特异度91.4%。结论不同病理分级食管胃结合部腺癌患者能谱CT各参数值差异有统计学意义,CT能谱成像为术前评估食管胃结合部腺癌患者病理分级提供了新指标。

Objective To evaluate the value of gemstone spectral imaging(GSI)quantitative parameters in the assessment of pathological grade of adenocarcinoma of esophagogastric junction before operation.Methods Prospectively analyze 59 patients with esophagogastric junction carcinoma confirmed by electronic digestive tract endoscopy and surgical pathology results.All patients received routine chest-abdomen plain scan and energy spectrum CT dual-phase enhanced scan,then measure and calculate lesion enhancement value(Hu),standardized iodine concentration(NIC),standardized effective atomic number(Zeff-a),energy spectrum curve Average slope(λHu).Kruskal-Wallis H test and One-way ANOVA were used to evaluate the differences of quantitative parameters between different pathological grades and T staging.The ROC was plotted to evaluate the efficiency of different parameters in diagnosis of the poor-differentiated esophagogastric junction adenocarcinoma.Results The differences of NIC,λHu,Zeff-a and Hu between different pathological grading groups were statistically significant in arterial phase and venous phase(all P<0.05).There were positive correlation between NIC,λHU,Zeff-a,Hu and the pathological grading(P<0.01).The best diagnostic efficiency for differentiate poorly differentiated esophagogastric junction adenocarcinoma was NIC in arterial phase with AUC,the cut off value,sensitivity,specificity of 0.961,0.125,95.8%,91.4%,respectively.Conclusion There are significant differences in the energy spectrum parameters between different pathological grades of esophagogastric junction adenocarcinoma,and CT spectroscopy can provide a new index for preoperative assessment of esophagogastric junction adenocarcinoma pathological grade.