宝石能谱CT成像在食管癌术前分期和病理分级预测中的价值

The Value of Gemstone Spectral CT Imaging in Preoperative Staging Diagnosis and Pathological Grading Prediction of Esophageal Cancer

目的分析宝石能谱CT成像对于食管癌术前分期和病理分级预测的价值。方法回顾性分析2020年9月-2022年1月我院于术前行能谱CT扫描的60例食管癌患者,均有病理结果证实,记录及定量分析,且与术后病理分期进行比较,比较食管癌不同病理分级间标准化碘浓度值(NIC值)、70keV的CT值及能谱曲线斜率(K值),对不同病理分级标准化碘浓度值进行ROC曲线分析。结果食管癌患者经能谱CT扫描后行术前T分期的准确率为88.3%,行N分期的准确率为86.67%,相较于病理结果T分期和N分期一致性较高(Kappa值分别为0.700,P<0.05)。不同病理分级食管癌70keV的CT值、NIC值及K值不同,组与组间动脉期、静脉期的NIC值、静脉期70keV的CT值以及K值差异均有统计学意义(P<0.05)。动脉期和静脉期标准碘浓度值诊断食管癌中高分化组和低分化组ROC曲线下面积分别为0.804、0.832。结论宝石能谱CT成像(GSI)不仅能够对食管癌患者进行术前分期评估,而且可以根据动、静脉期NIC值反映出食管癌的分化程度,为临床诊断分期、手术方案选的制定、预后评估提供十分必要的依据。

Objective To analyze the value of gemstone energy spectrum CT imaging in predicting the preoperative stage and pathological grade of esophageal cancer.Methods A retrospective analysis was performed on 60 patients with esophageal cancer who underwent energy spectrum CT scanning before surgery in our hospital from September 2020 to January 2022.All of them were confirmed by pathological results,recorded and quantitatively analyzed,and compared with postoperative pathological stages.The standardized iodine concentration value(NIC value),CT value of 70keV and slope of energy spectrum curve(K value)were compared among different pathological grades of esophageal cancer,and ROC curve analysis was performed for standardized iodine concentration value of different pathological grades.Results The accuracy rate of preoperative T staging and N staging was 88.3%and 86.67%respectively after energy spectrum CT scan,which showed higher consistency between T staging and N staging compared with pathological results(Kappa value was 0.700,P<0.05).The CT value,NIC value and K value of 70keV in esophageal cancer of different pathological grades were different,and the NIC value in arterial stage,venous stage,CT value and K value in venous stage were significantly different between groups(P<0.05).The area under ROC curve of the highly differentiated group and the poorly differentiated group was 0.804 and 0.832,respectively.Conclusion Gemstone energy spectrum CT imaging(GSI)can not only evaluate the preoperative staging of patients with esophageal cancer,but also reflect the degree of differentiation of esophageal cancer according to the NIC value of arteriovenous stage,which provides a very necessary basis for clinical diagnosis and staging,operation plan selection and prognosis evaluation.