双能量CT定量参数预测乳腺浸润性导管癌病理分级及乳腺癌分子亚型的研究

Study on Quantitative Parameters of Dual energy CT to Predict Pathological Grade and Molecular Subtype of Invasive Ductal Carcinoma Of Breast

目的 探讨双能量CT定量参数对乳腺浸润性导管癌(IDC)病理分级及分子亚型的预测价值。方法收集2022年1月至2023年6月在本院经病理证实的63例IDC患者的病例资料。患者均行双能量CT胸部双期增强扫描,将双期能量CT图像导入工作站进行后处理,记录病灶和主动脉分别在动脉期及静脉期的碘浓度和归一化有效原子序数;在单能谱程序中获得病灶分别在动静脉期40-70kev不同单能级时的CT值。将病灶分为高、低分化组及4种亚型。对比不同分化程度IDC定量参数的差异及定量参数与乳腺癌病理分化程度之间的相关性。采用ROC曲线评价定量参数对不同分化程度病灶的鉴别诊断效能。结果63例IDC患者中,除静脉期λ值外,高分化组与低分化组的各定量参数值均存在显著差异;动脉期中病灶的IC、 SIC、λ、nZeff值与分化程度之间呈正相关;动脉期λ值的ROC曲线下面积最大(0.954),对应敏感度为83.25%,特异度为69.05%。结论 双能量CT定量参数对IDC病理分级及分子亚型具有一定的预测价值,值得在临床上大力推广。

Objective To investigate the value of dual-energy CT quantitative parameters in predicting the pathological grade and molecular subtype of invasive ductal carcinoma of breast.Methods From January 2022 to June 2023,63 patients with invasive ductal carcinoma of breast confirmed by pathology were collected.All patients underwent dual-energy CT chest dual-phase enhanced scan,and the reconstructed images of dual-phase energy CT scan were imported into workstation for image post-processing.Iodine concentration and normalized effective atomic number of the lesion and aorta in the arterial and venous phases were recorded and the CT values of the lesions in different single energy levels of 40-70kev in the arteriovenous phase were obtained.Patients were divided into highly differentiated group and poorly differentiated group and breast cancer was divided into four subtypes.To compare the quantitative parameters of breast infiltrating ductal carcinoma with different degrees of differentiation.To analyze the correlation between quantitative parameters and pathological differentiation degree of breast cancer.ROC curve was used to evaluate the differential diagnostic efficacy of quantitative parameters for different degrees.Results There were significant differences in the quantitative parameters between the highly differentiated group and the poorly differentiated group,except for values of the venous phase.There was a positive correlation between IC,SIC,,nZeff values and differentiation degree in arterial midphase lesions.The area under ROC curve of the arterial phase values was the largest(0.954),the corresponding sensitivity was 83.25%,and the specificity was 69.05%.Conclusion Quantitative parameters of dual-energy CT have certain value in predicting pathological grade and molecular subtype of invasive ductal carcinoma of breast.