能谱CT定量评估乳腺浸润性导管癌分化程度的初步研究

A Preliminar y Study on Quantitative Evaluation of Differentiation Degree of Invasive Ductal Carcinoma by Spectrum CT

目的探讨能谱CT曲线和标准化碘浓度(NIC)在判断乳腺浸润性导管癌(IDC)分化程度中的价值。方法分析经手术病理证实并术前行能谱CT扫描的55例IDC患者的资料,分为高分化组(病理Ⅰ、Ⅱ级)44例、低分化组(病理Ⅲ级)11例,测量并分别比较动脉期和静脉期两组的能谱曲线(40~100keV)、NIC的规律、差异。采用受试者工作特征曲线(ROC)分别分析比较动、静脉期能谱曲线斜率、NIC对IDC分化程度的诊断效能。结果在40~100keV时,低分化组能谱曲线斜率高于高分化组能谱曲线斜率,差异具有统计学意义(P<0.05);低分化组病例NIC值大于高分化组(P<0.05)。ROC曲线显示:以高-低分化组NIC(V)0.47作为鉴别高低分化IDC的阈值,其诊断效能最高[曲线下面积(AUC)0.91,敏感度83.75%,特异度88.00%]。结论IDC的能谱曲线斜率和NIC可于术前提示IDC病理组织分化程度。

Objective To explore the value of spectrum CT curve and normalized iodine concentration(NIC)in the diagnosis of invasive ductal carcinoma(IDC).Methods The radiographic data of 55 cases with pathologically confirmed IDC were analyzed retrospectively,including 44 well-moderated differentiated(grade Ⅰ,grade Ⅱ),and 11 poorly differentiated neoplasms(grade Ⅲ),all patients underwent spectrum CT.The slope of spectrum energy curves(40~100keV)of two grades of differentiation at arterial stage and venous stage were measured and compared.The area under receiver operating characteristic(ROC)curves were used to evaluate the diagnostic accuracy of artery and venous energy spectrum curve slope and NIC in IDC differentiation degree.Results In the spectrum energy curve 40~100 keV,the slope of spectrum of poorly differentiated group was higher than that of wellmoderated differentiated group,the difference was statistically significant(P<0.05);The NIC of poorly differentiated group was higher than that of well-moderated differentiated group,the difference was statistically significant(P<0.05).From ROC curves:When NIC(V)value of 0.47 was used as the threshold of differentiating well and poor IDC,the sensitivity,specificity and the area under the curve were 83.75%,88.00%,and 0.91 respectively.Conclusion The slope of spectrum energy curve and the NIC is correlated with the differentiation degree of IDC.