光谱CT碘浓度值相关参数诊断胃腺癌区域淋巴结转移的效能

Efficiency of spectral CT iodine concentration value related parameters in diagnosis of regional lymph node metastasis of gastric adenocarcinoma

目的分析基于胃癌病灶和淋巴结的光谱CT碘浓度(IC)值相关定量参数评估胃腺癌患者区域淋巴结转移的效能。方法回顾性收集2021年6月至2022年6月中国医科大学附属盛京医院经病理证实的55例胃腺癌的临床资料及术前光谱CT图像。依据病理结果中所有送检淋巴结中是否有转移淋巴结将患者分为淋巴结转移病灶组(32例)和淋巴结未转移病灶组(23例)。再以淋巴结为研究对象,根据病理报告上记录的淋巴结的性质将纳入研究的淋巴结分为转移淋巴结组(25枚)和未转移淋巴结组(27枚)。获取动静脉期胃癌病灶及淋巴结的IC值(ICa和ICp)、标准化IC(nIC)值(nICa和nICp),计算病灶和淋巴结的动静脉期IC和nIC值的差值∆IC和∆nIC,计算淋巴结ICa与ICp的比值动脉增强分数(AEF)。采用独立样本t检验或Mann-Whitney U检验比较2组间定量参数的差异,将差异有统计学意义的参数进行受试者操作特征曲线分析,获得各参数评估胃癌淋巴结转移的诊断效能,并采用Z检验比较各参数的曲线下面积(AUC)。结果淋巴结转移病灶组的ICp、nICp、∆IC、∆nIC均高于淋巴结未转移病灶组(P均<0.05),AUC分别为0.738、0.746、0.811、0.821。转移淋巴结组的淋巴结短径、ICa、nICa、AEF值均高于未转移淋巴结组(P均<0.05),AUC分别为0.821、0.832、0.734、0.863。胃癌病灶ICp与∆IC、∆nIC的AUC差异有统计学意义(Z=2.41、3.29,P=0.016、0.001),nICp与∆IC、∆nIC间的AUC差异有统计学意义(Z=2.10、3.09,P=0.036、0.002)。淋巴结nICa与ICa、AEF间的AUC差异有统计学意义(Z=2.09、2.41,P=0.037、0.016)。结论光谱CT IC值相关定量参数可用于评估胃腺癌患者区域淋巴结性质,其中病灶的∆IC、∆nIC和淋巴结的AEF值效能最优。

Objective To analyze the efficacy of quantitative parameters related to spectral CT iodine concentration(IC)values in evaluating regional lymph node metastasis in patients with gastric adenocarcinoma.Methods The clinical data and CT images of 55 patients with gastric adenocarcinoma diagnosed by pathology from June 2021 to June 2022 were collected retrospectively at Shengjing Hospital of China Medical University.Patients were divided into lymph node metastatic lesion group(32 cases)and lymph node non-metastatic lesion group(23 cases)according to whether there were metastatic lymph nodes in all the lymph nodes examined in the pathological results.Then lymph nodes were taken as the research object,and all lymph nodes were divided into the metastatic lymph node group(25 lymph nodes)and the non-metastatic lymph node group(27 lymph nodes)according to the nature of lymph nodes recorded in the pathological report.The IC values and normalized IC(nIC)values of gastric cancer lesions and lymph nodes in the arterial and venous phases(ICa and ICp,nICa and nICp)were obtained.The difference of IC and nIC values between arterial and venous phases(∆IC and∆nIC)were calculated,and the arterial enhancement fraction(AEF,ratio of ICa and ICp of lymph nodes)was calculated.Student′s t test or Mann-Whitney U test was used to compare the differences of quantitative parameters between the two groups.The parameters with statistical differences were analyzed by the receiver operating characteristic curve to obtain the diagnostic efficacy of each parameter in evaluating lymph node metastasis of gastric cancer,and the Z test was used to compare the area under the curve(AUC)of each parameter.Results The ICp,nICp,∆IC and∆nIC of the lymph node metastatic lesion group were higher than those of the lymph node non-metastatic lesion group(all P<0.05).The AUC were 0.738,0.746,0.811 and 0.821.The short diameter,ICa,nICa and AEF values of lymph nodes in the metastatic lymph node group were higher than those in the non-metastatic lymph node group(all P<0.05).The AUC were 0.821,0.832,0.734 and 0.863.There were significant differences in AUC between ICp and∆IC,∆nIC(Z=2.41,3.29,P=0.016,0.001),and between nICp and∆IC,∆nIC(Z=2.10,3.09,P=0.036,0.002)in gastric cancer lesions.There were statistically significant differences in AUC between nICa and ICa,AEF(Z=2.09,2.41,P=0.037,0.016)in lymph nodes.Conclusions The quantitative parameters related to IC values of spectral CT can be applied to evaluate the properties of regional lymph nodes in patients with gastric adenocarcinoma,where∆IC,∆nIC of lesions and AEF of lymph nodes have the best efficacy.