双源CT双能量虚拟平扫对直肠癌壁外血管侵犯的诊断价值

Diagnostic Value of Dual-source CT Dual-energy Virtual Non-contrasting Extramural Vascular Invasions of Rectal Cancer

目的:探讨双源CT双能量虚拟平扫(VNC)对直肠癌壁外血管侵犯(EMVI)的术前诊断价值。方法:选取2019年11月至2021年12月间拟手术治疗的150例直肠癌患者术前行双源CT双能量虚拟平扫,女性64例(42.7%)、男性86例(57.3%),平均年龄为(62.3±11.8)岁。两名高年资影像科医师独立分析术前影像资料(包括ctEMVI情况及有无局部淋巴结浸润和远处转移),判断是否存在术前EMVI。以手术病理结果为金标准,分别评价VNC诊断EMVI的敏感性、特异性、准确性、阳性预测值和阴性预测值并采用受试者操作特征(ROC)曲线下面积评价其诊断效能。结果:150例直肠癌患者中,术后病理证实56例(37.3%)为EMVI阳性,94例(62.7%)为EMVI阴性。医师1对EMVI评价准确性、敏感性、特异性、阳性预测值、阴性预测值分别为86%、80.36%、89.36%、81.82%、88.42%,AUC为0.831(95%CI 0.756~0.905);医师2的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为88.67%、80.36%、93.62%、88.24%、88.89%,AUC为0.870(95%CI 0.802~0.938),医师1与医师2的评估结果一致性较高(k=0.943)。结论:双源CT双能量虚拟平扫对直肠癌EMVI术前评估具有一定的诊断价值。

Objective:To investigate the value of dual-source CT dual-energy virtual plain scan in the preoperative diagnosis of extramural vascular invasion(EMVI)in rectal cancer.Methods:A total of 150 patients with rectal cancer(64 females(42.7%)and 86 males(57.3%),with an average age of(62.3±11.8)years)who were scheduled for surgical treatment in our hospital from November 2019 to December 2021 were selected for the preoperative dual-source CT dual-energy virtual plain scan;.Two senior radiologists independently analyzed preoperative imaging data(including ctEMVI status,local lymph node infiltration,and distant metastasis)to determine the existence of preoperative EMVI.With pathological results as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of VNC in the diagnosis of EMVI were evaluated,and the area under the receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficiency.Results:Among 150 patients with rectal cancer,56(37.3%)were positive for EMVI and 94(62.7%)were negative for EMVI.The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of EMVI evaluation by physician 1 were 86%,80.36%,89.36%,81.82%,and 88.42%,respectively,and the AUC was 0.831(95%CI,0.756~0.905).The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of physician 2 were 88.67%,80.36%,93.62%,88.24%,and 88.89%,respectively,and the AUC was 0.870(95%CI,0.802~0.938).The consistency of the evaluation results between physician 1 and physician 2 was high(k=0.943).Conclusion:Dualsource CT dual-energy virtual plain scan has a certain diagnostic value in the preoperative evaluation of EMVI of rectal cancer.