能谱CT对进展期胃癌患者淋巴结转移、脉管生成及临床预后的评估价值研究

The Value of Energy Spectrum CT in Evaluating Lymph Node Metastasis,Vasculogenesis and Clinical Prognosis in Patients with Advanced Gastric Cancer

目的探讨能谱CT对于进展期胃癌患者淋巴结转移、脉管生成及临床预后的评估价值,以期为胃癌的无创评估和预测患者预后提供真实的影像学证据。方法选择2019年1月-2021年7月本院收治的86例临床进展期胃癌患者,所有患者于术前一周内行能谱CT检查。以病理结果为金标准,分为淋巴结转移组(36例)和非淋巴结转移组(50例)、脉管生成组(42例)和非脉管生成组(44例),对所有患者进行1年的随访并根据其生存情况分为死亡组(16例)和生存组(70例);分别比较淋巴结转移组与非淋巴结转移组之间、脉管生成组与非脉管生成组之间、死亡组与生存组之间能谱CT各参数的差异,通过绘制受试者工作特征曲线并计算曲线下比较能谱CT对进展期胃癌患者淋巴结转移、脉管生成的诊断效能以及临床预后评估价值。结果进展期胃癌患者淋巴结转移组、脉管生成组、死亡组中动脉期碘浓度、门脉期碘浓度、动脉期能谱曲线斜率均分别显著高于非淋巴结转移组、非脉管生成组、生存组,且差异具有统计学意义(P<0.05)。与动脉期碘浓度、门脉期碘浓度、动脉期能谱曲线斜率单独诊断相比较,联合诊断对淋巴结转移、脉管生成以及死亡预测的诊断效能最高,且差异具有统计学意义(P<0.05)。结论能谱CT定量参数对进展期胃癌患者的淋巴结转移、脉管生成有一定的鉴别诊断价值,而且可以有效预测患者的生存预后情况,有助于为指导临床治疗方案的选择提供真实的影像学证据。

Objective To explore the evaluation value of energy spectrum CT in lymph node metastasis,vasculogenesis and clinical prognosis of patients with advanced gastric cancer,so as to provide real imaging evidence for non-invasive evaluation and prognosis prediction of patients with gastric cancer.Methods 86 patients with clinically advanced gastric cancer admitted to our hospital from January 2019 to July 2021 were selected.All patients were examined with energy spectrum CT within one week before operation.According to the pathological results as the gold standard,the patients were divided into lymph node metastasis group(36 cases),non lymph node metastasis group(50 cases),vasculogenesis group(42 cases)and non vasculogenesis group(44 cases).All patients were followed up for one year and were divided into death group(16 cases)and survival group(70 cases)according to their survival conditions;The differences of various parameters of energy spectrum CT between lymph node metastasis group and non lymph node metastasis group,between vasculogenesis group and non vasculogenesis group,and between death group and survival group were compared respectively.The diagnostic efficacy and clinical prognostic evaluation value of energy spectrum CT for lymph node metastasis and vasculogenesis of patients with advanced gastric cancer were compared by drawing the working characteristic curve of subjects and calculating the curve.Results In patients with advanced gastric cancer,the iodine concentration in arterial phase,the iodine concentration in portal phase,and the slope of energy spectrum curve in arterial phase in lymph node metastasis group,vasculogenesis group,and death group were significantly higher than those in non lymph node metastasis group,non vasculogenesis group,and survival group,and the difference was statistically significant(P<0.05).Compared with the single diagnosis of iodine concentration in arterial phase,portal phase and slope of energy spectrum curve in arterial phase,the combined diagnosis has the highest diagnostic efficacy in predicting lymph node metastasis,vasculogenesis and death,and the difference is statistically significant(P<0.05).Conclusion The quantitative parameters of energy spectrum CT have a certain value in differential diagnosis of lymph node metastasis and vasculogenesis in patients with advanced gastric cancer,and can effectively predict the survival prognosis of patients,which is helpful to provide real imaging evidence for guiding the selection of clinical treatment plans.