能谱CT参数联合肿瘤标记物对胃癌分化程度的诊断价值分析

Analysis of the diagnostic value of spectral ct parameters combined with tumor markers for the degree of differentiation in gastric cancer

目的探讨能谱CT参数联合肿瘤标记物对胃癌分化程度的诊断价值。方法收集华北理工大学附属医院2022年3月~2023年7月收治的70例胃腺癌患者,经病理活检确诊为中高分化胃癌29例,低分化胃癌41例。测量并记录病灶动、静脉期的水基值(WC)、碘基值(IC)、标准化碘基值(nIC)、能谱曲线斜率(λ)以及肿瘤标记物数值。采用t检验分析中高分化组和低分化组胃癌能谱参数及肿瘤标记物之间的差异。绘制ROC曲线,得出各参数及联合参数曲线下面积(AUC),评估各参数及联合参数的诊断效能。结果低分化组胃癌患者静脉期能谱参数IC、nIC、λ、肿瘤标记物糖类抗原199(CA-199)均高于中高分化组(P<0.001)。其余参数组间比较无明显差异(P>0.05)。绘制病灶静脉期IC、nIC、λ、CA-199及其联合参数的ROC曲线,得出联合参数静脉期nIC+静脉期λ+CA-199的诊断效能最高,AUC为0.942,灵敏度80.50%、特异度96.60%,约登指数0.771。结论能谱CT参数联合肿瘤标记物对于胃癌的分化程度具有一定的诊断价值。

Objective To explore the diagnostic value of spectral CT parameters combined with tumor markers for the degree of differentiation in gastric cancer.Methods A total of 70 patients with gastric adenocarcinoma admitted to the Affiliated Hospital of North China University of Science and Technology from March 2022 to July 2023 were collected.Among them,29 cases were confirmed as moderately to well-differentiated gastric cancer and 41 cases were poorly differentiated gastric cancer by pathological biopsy.The water-based value(WC),iodine-based value(IC),normalized iodine-based value(nIC),spectral curve slope(λ),and tumor marker values were measured and recorded.The t-test was used to analyze the differences in spectral parameters and tumor markers between the moderately to well-differentiated group and the poorly differentiated group.ROC curves were plotted to obtain the area under the curve(AUC)of each parameter and combined parameters,and the diagnostic efficiency of each parameter and combined parameters was evaluated.Results The spectral parameters IC,nIC,λ,and tumor marker carbohydrate antigen 199(CA-199)in the venous phase of the poorly differentiated gastric cancer group were higher than those in the moderately to well-differentiated group(P<0.001).There was no significant difference in other parameters between the groups(P>0.05).The ROC curves of IC,nIC,λ,CA-199,and their combined parameters in the venous phase of the lesion were plotted,and the diagnostic efficiency of the combined parameter of venous phase nIC+venous phaseλ+CA-199 was the highest,with an AUC of 0.942,a sensitivity of 80.50%,a specificity of 96.60%,and a Youden index of 0.771.Conclusion Spectral CT parameters combined with tumor markers have certain diagnostic value for the degree of differentiation in gastric cancer.