双源双能量CT碘值测定在胃癌术前T分期诊断中的价值

Value of Dual-source Dual-energy CT Iodine Determination in Preoperative T Stage Diagnosis of Gastric Cancer

目的探讨双源双能量CT碘值测定在胃癌术前T分期诊断中的应用价值。方法选取2022年4—5月在福建省立医院放射科接受双源双能量CT,后经手术病理诊断确诊为T分期的138例胃癌患者。患者均采用双源双能量CT检查。比较T_(1)期、T_(2~3)期患者动脉期、静脉期正常胃壁、胃壁内层、胃壁外层碘含量,比较40、60、120 keV时影像学图像质量主观指标与客观指标。结果T_(1)期、T_(2~3)期患者动脉期、静脉期胃壁内层与胃壁外层碘含量比较,差异有统计学意义(P<0.001);胃壁内层与正常胃壁碘含量比较,差异有统计学意义(P<0.001);胃壁外层与正常胃壁碘含量比较,差异无统计学意义(P=0.130、0.262、0.231、0.022)。60 keV[(3.28±0.38)分]时总体图像质量评分高于40、120 keV[(3.01±0.43)、(3.14±0.41)分],差异有统计学意义(P<0.001,P=0.004);40 keV与60 keV、40 keV与120 keV、60 keV与120 keV病灶显著性评分比较,差异均无统计学意义(P=0.129、0.054、0.713)。40keV时CT值、图像噪声、信噪比(signal-noise ratio,SNR)、对比度噪声比(clinical nursing research,CNR)高于60、120keV时,60 keV时CT值、图像噪声、SNR、CNR高于120keV时,差异有统计学意义(P<0.001)。结论采用双源双能量CT碘值测定方式,对于鉴别诊断T_(1)期、T_(2~3)期胃癌具有一定价值,且能够提高图像的质量,对于提高胃癌术前T分期的准确率有重要意义。

Objective To investigate the application value of dualsource dual-energy CT iodine determination in preoperative T-stage diagnosis of gastric cancer.Methods A total of 138 patients with gastric cancer who underwent dual-source dual-energy CT and were diagnosed as T stage by surgical pathology in the Department of Radiology,Fujian Provincial Hospital from April to May 2022 were selected.All patients were examined by dual-source dual-energy CT.The contents of iodine in normal gastric wall,inner gastric wall and outer gastric wall were compared between T_(1) and T_(2-3) patients in arterial and venous stages,the subjective and objective indexes of image quality at 40,60 and 120 keV were compared.Results There was significant difference in iodine content between the inner and outer gastric wall of patients in arterial and venous stages T_(1) and T_(2-3)(P<0.001);the iodine content in the inner gastric wall was significantly different from that in normal gastric wall(P<0.001);there was no significant difference in iodine content between outer gastric wall and normal gastric wall(P=0.130,0.262,0.231,0.022).The overall image quality score of 60 keV[(3.28±0.38)points]was higher than that of 40,120 keV[(3.01±0.43),(3.14±0.41)points],and the differences were statistically significant(P<0.001,P=0.004);there were no significant differences in lesion significance scores between 40 keV and 60 keV,40 keV and 120 keV,60 keV and 120 keV(P=0.129,0.054,0.713).At 40 keV,CT value,image noise,signal-noise ratio(SNR),clinical nursing research(CNR)were higher than at 60 and 120 keV,and at 60 keV,CT value,image noise,SNR and CNR were higher than at 120 keV,the differences were statistically significant(P<0.001).Conclusion The use of dual-source dual-energy CT iodine determination method has certain value for the differential diagnosis of T_(1) and T2~3 gastric cancer,and can improve the image quality,and has important significance for improving the accuracy of preoperative T staging of gastric cancer.