双源CT对结直肠癌淋巴结转移的鉴别价值

Differential value of dual-source CT in lymph node metastasis of colorectal cancer

目的:评估双源CT对结直肠癌淋巴结转移的鉴别价值。方法:收集皖南医学院弋矶山医院46例(47个病灶)经组织病理学确诊为结直肠癌患者的临床及双源CT影像资料,选出转移性与非转移性淋巴结并比较两者形态学及能谱参数的差异,采用多因素Logistic回归分析建立淋巴结形态和影像学参数预测淋巴结转移的模型,绘制ROC曲线评价其预测效能。所有病例根据术后病理分为脉管/神经侵犯组与未侵犯组,比较脉管侵犯与淋巴结转移的差异性。结果:转移性淋巴结与非转移性淋巴结长径及短径的差异、动静脉期的碘值、Overlay值、标准化碘浓度和能谱曲线斜率的差异均有统计学意义(P<0.05);其中静脉期Overlay值和标准化碘浓度的诊断效能较高,曲线下面积分别为0.860和0.794;淋巴结形态和影像学参数预测淋巴结转移模型预测淋巴结转移的曲线下面积为0.910。脉管/神经侵犯与淋巴结转移具有相关性。结论:双源CT对鉴别转移性淋巴结与非转移性淋巴结具有一定临床价值。

Objective:To evaluate the value of dual-source CT in differential diagnosis of lymph node metastasis of colorectal cancer.Methods:The clinical and dual-source CT imaging data of 46 patients with colorectal cancer diagnosed by histopathology in our hospital were collected.Metastatic and non-metastatic lymph nodes were screened according to the criteria,and the differences of morphological and energy spectrum parameters between metastatic and non-metastatic lymph nodes were compared.Multivariable logistic regression analysis was used to establish the model of lymph node morphology and imaging parameters to predict lymph node metastasis,and ROC curves were drawn to evaluate the predictive efficiency.All cases were divided into vascular/nerve invasion group and non-invasion group according to postoperative pathology,and the differences between vascular invasion and lymph node metastasis were compared.Results:There were significant differences in long and short diameter,iodine value,Overlay value,standardized iodine concentration and slope of energy spectrum curve in arteriovenous phase between metastatic and non-metastatic lymph nodes(P<0.05).The diagnostic efficiency of Overlay value and standardized iodine concentration in venous phase was higher,and the area under the curve was 0.860 and 0.794,respectively.The area under the curve of lymph node metastasis predicted by lymph node morphology and imaging parameters was 0.910.There was a correlation between vascular/nerve invasion and lymph node metastasis.Conclusion:Dual-source CT has certain clinical value in differentiating metastatic lymph nodes from non-metastatic lymph nodes.