双能CT碘定量参数评估卵巢癌p53状态的价值

Value of dual energy CT iodine quantitative parameters in evaluating the status of p53 in epithelial ovarian cancer

目的:探讨双能CT碘定量参数评估卵巢癌p53状态的价值。资料与方法:回顾性分析术前行双能CT扫描的82例卵巢癌(p53突变型51例,p53野生型31例)患者资料。两名观察者分别独立测量并计算增强动脉期、静脉期和延迟期标准化碘浓度(AP-NIC、VP-NIC、DP-NIC)。组内相关系数(ICC)用于比较两位观察者获得AP-NIC、VP-NIC、DP-NIC的一致性,采用独立样本t检验或秩和检验比较上述参数在两组间的差异,采用Logistic回归分析联合有差异的参数。曲线下面积(AUC)、敏感度和特异度用于评估单变量效能及联合模型效能。DeLong检验用于对比单变量和联合模型AUC差异。结果:所有参数值的一致性均较好(ICC>0.75)。p53突变型卵巢癌增强三期NIC均明显高于p53野生型卵巢癌(0.08vs.0.05,0.35vs.0.16,0.50vs.0.26,所有P<0.05)。AP-NIC、VP-NIC和DP-NIC的AUC分别为0.686、0.720和0.715。由AP-NIC、VP-NIC和DP-NIC组成的联合模型AUC为0.723,但与各单变量AUC无明显差异(P>0.05)。结论:双能CT碘定量参数为卵巢癌患者治疗前无创性预测p53突变状态提供了新的检查方法。

Objective:To evaluate the value of dual energy CT iodine quantitative parameters in evaluating the status of p53 in epithelial ovarian cancer.Methods:Total of 82 patients with ovarian cancer who underwent energy spectrum CT scan-ning before operation(51 cases of p53 mutation and 31 cases of wild type)were analyzed retrospectively.The two observers independently measured iodine concentrations(AP-IC,VP-IC,DP-IC)and normalized iodine concentrations(AP-NIC,VP-NIC,DP-NIC)in enhanced arterial phase,venous phase and delayed phase,respectively.Intra-group correlation coefficient(ICC)was used to compare the consistency of AP-NIC,VP-NIC and DP-NIC measured by two observers.Independent sample t-test or rank sum test was used to compare the differences of AP-NIC,VP-NIC and DP-NIC between the two groups.Logistic re-gression was used to combine the different parameters in univariate analysis.The area under the curve(AUC),sensitivity and specificity were used to evaluate the effectiveness of univariate and combined models.DeLong test was used to compare the AUC differences between univariate and combined models.Results:The values of all parameters are consistent(ICC>0.75).The enhanced NIC of p53 mutant ovarian cancer were significantly higher than those of wild type ovarian cancer(0.08 vs.0.05,0.35 vs.0.16,0.50 vs.0.26,all P<0.05).The AUC of AP-NIC,VP-NIC and DP-NIC were 0.686,0.720 and 0.715,respec-tively.The combined model consisting of AP-NIC,VP-NIC and DP-NIC obtained the AUC of O.723,but there was no signif-icant difference between it and each single variable(P>0.05).Conclusion:Dual energy CT iodine quantitative parameters pro-vide a new method for non-invasive prediction of p53 mutation in patients with ovarian cancer before treatment.