术前双能量CT定量参数预测临床Ⅰ~Ⅱ期胃腺癌侵袭性病理特征

Preoperative dual energy CT quantitative parameters for predicting invasive pathological features of clinical stageⅠandⅡgastric adenocarcinoma

目的观察术前双能量CT(DECT)定量参数预测临床Ⅰ~Ⅱ期胃腺癌侵袭性病理特征的价值。方法回顾性分析66例术前临床Ⅰ~Ⅱ期胃腺癌术前腹部增强DECT,其中病理分期Ⅰ~Ⅱ期56例、Ⅲ期10例,33例中-高分化、33例低分化,41例淋巴血管侵犯(LVI)(-)、25例LVI(+),28例神经周围侵犯(PNI)(-)、38例PNI(+);比较不同病理特征(病理分期、分化程度、LVI和PNI)病灶之间动脉期、静脉期及延迟期标准化碘浓度(NIC)及能谱曲线斜率(λHU)的差异。针对组间差异有统计学意义的参数绘制受试者工作特征(ROC)曲线,评估其预测病理分期Ⅲ期的效能。结果病理Ⅲ期组与病理Ⅰ~Ⅱ期组,中-高分化组与低分化组,LVI(+)组与LVI(-)组,以及PNI(+)组与PNI(-)组之间,静脉期NIC及λHU差异均有统计学意义(P均<0.05)。中-高分化组与低分化组、LVI(+)组与LVI(-)组之间延迟期λHU,PNI(+)组与PNI(-)组之间动脉期和延迟期λHU差异均有统计学意义(P均<0.05),组间其余DECT定量参数差异均无统计学意义(P均>0.05)。以静脉期NIC和静脉期λHU预测临床Ⅰ~Ⅱ期胃腺癌病理分期为Ⅲ期的曲线下面积(AUC)分别为0.739和0.753。结论术前DECT定量参数可预测临床Ⅰ~Ⅱ期胃腺癌侵袭性病理特征。

Objective To investigate the value of preoperative dual energy CT(DECT)quantitative parameters for predicting invasive pathological features of clinical stageⅠ-Ⅱgastric adenocarcinoma.Methods Preoperative enhanced abdominal DECT images of 66 patients with clinical stageⅠ-Ⅱgastric adenocarcinoma were retrospectively analyzed.Among 66 cases,56 were pathological stageⅠ-Ⅱand 10 were pathological stageⅢ,33 were middle-high differentiation and 33 were poor differentiation,41 were lymphovascular invasion(LVI)(-)and 25 were LVI(+),while 28 were perineural invasion(PNI)(-)and 38 were PNI(+).The normalized iodine concentration(NIC)and the slope of the energy spectrum curve(λHU)in arterial,venous and delayed phases of lesions were compared between different pathological features(i.e.pathological stage,tumor differentiation,LVI and PNI).Receiver operating characteristic(ROC)curves of parameters being significant different between different pathological feature groups were drawn to observe the values of predicting clinical stageⅠ-Ⅱgastric adenocarcinoma as pathological stageⅢ,and efficacies were analyzed.Results There were significant differences of NIC andλHUof venous phase between pathological stageⅢgroup andⅠ-Ⅱgroup,medium-highly differentiated group and poorly differentiated group,LVI(+)group and LVI(-)group,also PNI(+)group and PNI(-)group(all P<0.05).Significant differences ofλHUat delayed stage was found between medium-high differentiation group and low differentiation group,LVI(+)group and LVI(-)group,also of arterial and delayed phasesλHUbetween PNI(+)group and PNI(-)group(all P<0.05).No significant difference of other DECT quantitative parameters was found between groups(all P>0.05).The area under the curve(AUC)of NIC and venous phaseλHUfor predicting clinical stageⅠ-Ⅱgastric adenocarcinoma as pathological stageⅢwas 0.739,0.753,respectively.Conclusion Preoperative DECT quantitative parameters could be used to predict invasive pathological features of clinical stageⅠ-Ⅱgastric adenocarcinoma.