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食管癌是消化系统常见的恶性肿瘤之一,据2018年公布的统计数据,我国食管癌发病率居恶性肿瘤中的第6位[1]。临床上具有早期症状不明显,误诊率和漏诊率高的特点。食管癌最易出现淋巴结转移,一旦发生转移,治疗难道增大,严重影响病人的生活质量及生存时间[2]。因此,术前明确病人是否存在淋巴结转移以及转移数目和范围,直接影响临床治疗方案的选择和预后评估。当前食管癌常用的影像学检查主要是X线钡餐造影、传统CT平扫及增强等。X线钡餐造影可较直观地显示病变部位、大小、形态,但无法显示腔外侵犯和淋巴结转移情况。传统CT扫描是诊断食管癌淋巴结转移最常用的方法,通常依据淋巴结的大小及形态学来判断是否存在淋巴结转移,但敏感性不高,存在较高的漏诊率和误诊率[3];且传统CT的X线属于混合能量射线,图像的判读容易受射线束硬化伪影的影响[4]。近来随着CT技术的不断发展,能谱CT成像因其多参数成像的优势,在食管癌术前诊断中的应用逐渐增多[5-6]。本研究旨在探究CT能谱成像在定性判断不同分化食管癌淋巴结转移中的应用价值。
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48例食管癌病人中,病变位于上段5例,中上段4例,中段17例,中下段8例,下段14例。高分化鳞癌11例,中分化鳞癌15例,低分化鳞癌22例。
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48例食管癌病人中,食管癌手术及病理证实伴淋巴结转移32例,无淋巴结转移16例。在食管癌CT能谱图像上相应标记淋巴结总共111枚,手术后经病理结果证实转移淋巴结共79枚,其中高、中、低分化鳞癌转移淋巴结分别是14枚、27枚和38枚;非转移性淋巴结32枚,能谱CT成像诊断淋巴结转移与手术后病理结果差异无统计学意义(P>0.05)(见表 1)。
分组 病理转移 病理非转移 合计 χ2 P 能谱CT转移 68 4 72 3.27 >0.05 能谱CT非转移 11 28 39 合计 79 32 111 表 1 能谱CT成像诊断淋巴结转移与手术后病理结果比较(n)
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高中分化食管鳞癌转移性淋巴结短径、动脉期CT70 keV、动静脉期NIC均高于非转移性淋巴结(P < 0.05~P < 0.01)(见表 2)。低分化食管鳞癌转移性淋巴结短径、动脉期CT70 keV、动静脉期NIC均高于非转移性淋巴结(P < 0.05~P < 0.01)(见表 3)。
分组 n 短径/mm 动脉期CT70 keV/Hu 动脉期NIC 静脉期NIC 转移淋巴结 41 9.37±2.95 69.52±18.23 0.24±0.07 0.63±0.10 非转移淋巴结 32 6.52±3.02 51.79±14.48 0.15±0.05 0.44±0.15 t — 2.12 4.50 6.15 6.48 P — < 0.05 < 0.01 < 0.01 < 0.01 表 2 高中分化食管鳞癌不同性质淋巴结参数比较(x±s)
分组 n 短径/mm 动脉期CT70 keV/Hu 动脉期NIC 静脉期NIC 转移淋巴结 38 9.48±3.24 76.64±23.21 0.31±0.09 0.52±0.12 非转移淋巴结 32 6.52±3.02 51.79±14.48 0.15±0.05 0.44±0.15 t — 3.93 5.25 8.95 2.48 P — < 0.01 < 0.01 < 0.01 < 0.05 表 3 低分化食管鳞癌不同性质淋巴结参数比较(x±s)
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动脉期CT70 keV、动脉期NIC和能谱曲线斜率诊断食管癌转移性淋巴结的AUC值(95%CI)分别为0.75(0.69~0.82)、0.82(0.78~0.91)、0.80(0.73~0.86),当动脉期CT70 keV的阈值为65.22 HU时,敏感度和特异度分别为73.8%、82.2%;当动脉期NIC阈值为0.19时,敏感度和特异度分别为82.9%、85.4%;当动脉期能谱曲线斜率阈值为1.32时,敏感度和特异度为78.6%、81.1%。动脉期CT70 keV、动脉期NIC及能谱曲线斜率联合诊断食管癌转移淋巴结的敏感度和特异度分别为86.1%和87.5%。
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病例1,男,64岁,食管中下段低分化鳞癌,主肺动脉窗淋巴结转移(见图 1)。病例2,女,55岁,食管下段高分化鳞癌,气管隆突下淋巴结转移(见图 2)。病例3,男,67岁,食管中上段高分化鳞癌,气管旁非转移淋巴结(见图 3)。
能谱CT成像定性评估不同分化食管癌转移淋巴结的应用价值
Application value of the spectral CT imaging in the qualitative evaluation of metastatic lymph nodes of differently differentiated esophageal cancer
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摘要:
目的探讨能谱CT成像在定性评估不同分化食管癌转移淋巴结中的应用价值。 方法回顾性分析48例经内镜病理证实的食管鳞癌病人,术前均接受能谱CT胸部平扫及双期增强扫描,测量纵隔内淋巴结短径、动脉期70 keV下的CT值(CT70 keV)、动脉期及静脉期碘浓度,计算标准化碘浓度,并且与手术后病理结果相比较。 结果48例食管鳞癌病人中,食管癌手术及病理证实伴淋巴结转移32例,无淋巴结转移16例。经术后病理结果确认转移淋巴结79枚,其中高、中、低分化鳞癌转移淋巴结分别为14枚、27枚和38枚;非转移性淋巴结32枚,能谱CT成像诊断淋巴结转移与手术后病理结果差异无统计学意义(P>0.05)。高中分化食管鳞癌转移性淋巴结短径、动脉期CT70 keV、动静脉期标准化碘浓度均高于非转移性淋巴结(P < 0.05~P < 0.01)。低分化食管鳞癌转移性淋巴结短径、动脉期CT70 keV、动静脉期NIC均高于非转移性淋巴结(P < 0.05~P < 0.01)。ROC曲线分析显示,动脉期CT70 keV、动脉期标准化碘浓度及能谱曲线斜率联合诊断食管癌转移淋巴结的敏感度和特异度分别为86.1%和87.5%。 结论CT能谱成像在定性评估不同分化食管癌淋巴结中具有重要价值,能够为食管癌的N分期、临床诊断及治疗方案的选择提供帮助。 -
关键词:
- 食管肿瘤 /
- 转移淋巴结 /
- 体层摄影术,X线计算机
Abstract:ObjectiveTo explore the application value of spectral CT imaging in the qualitative evaluation of metastatic lymph nodes of differently differentiated esophageal cancer. MethodsThe clinical data of 48 patients with esophageal squamous cell carcinoma confirmed by endoscopic pathology were retrospectively analyzed.All cases were detected using spectral CT chest plain scan and dual-phase enhanced scan before surgery.The short diameter of mediastinal lymph nodes, CT value at 70 keV arterial and iodine concentration in arterial and venous phases were measured, the normalized iodine concentration was calculated, and which was compared with the postoperative pathological results. ResultsAmong the 48 patients with esophageal squamous cell carcinoma, 32 cases with lymph node metastasis and 16 cases without lymph node metastasis were confirmed by operation and pathology.The postoperative pathological results showed that 79 metastatic lymph nodes were found(including 14 highly differentiated squamous cell carcinoma metastatic lymph nodes, 27 moderately differentiated squamous cell carcinoma metastatic lymph nodes and 38 poorly differentiated squamous cell carcinoma metastatic lymph nodes), and there were 32 non-metastatic lymph nodes.There was no statistical significance in the diagnosis of lymph node metastasis between spectral CT imaging and pathological results after surgery(P>0.05).The short diameter, CT70 keV and arterial phase hormalized iodine concentration in highly and moderately differentiated esophageal squamous cell carcinoma metastatic lymph nodes were higher than those in non-metastatic lymph nodes(P < 0.05 to P < 0.01).The short diameter, CT70 keV and arterial phase hormalized iodine concentration in pooryly differentiated esophageal squamous cell carcinoma metastatic lymph nodes were higher than those in non-metastatic lymph nodes(P < 0.05 to P < 0.01).The ROC curve analysis showed that the sensitivity and specificity of the combined of CT70 keV, normalized iodine concentration and spectral curve slope in arterial phase in the diagnosis of metastatic lymph node of esophageal cancer were 86.1% and 87.5%, respectively. ConclusionsThe spectral CT imaging has important value in qualitative valuating the lymph nodes of differently differentiated esophageal cancer.It is helpful for N staging, clinical diagnosis and choice of treatment option of esophageal cancer. -
Key words:
- esophageal neoplasms /
- metastatic lymph node /
- tomography, X-ray computer
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表 1 能谱CT成像诊断淋巴结转移与手术后病理结果比较(n)
分组 病理转移 病理非转移 合计 χ2 P 能谱CT转移 68 4 72 3.27 >0.05 能谱CT非转移 11 28 39 合计 79 32 111 表 2 高中分化食管鳞癌不同性质淋巴结参数比较(x±s)
分组 n 短径/mm 动脉期CT70 keV/Hu 动脉期NIC 静脉期NIC 转移淋巴结 41 9.37±2.95 69.52±18.23 0.24±0.07 0.63±0.10 非转移淋巴结 32 6.52±3.02 51.79±14.48 0.15±0.05 0.44±0.15 t — 2.12 4.50 6.15 6.48 P — < 0.05 < 0.01 < 0.01 < 0.01 表 3 低分化食管鳞癌不同性质淋巴结参数比较(x±s)
分组 n 短径/mm 动脉期CT70 keV/Hu 动脉期NIC 静脉期NIC 转移淋巴结 38 9.48±3.24 76.64±23.21 0.31±0.09 0.52±0.12 非转移淋巴结 32 6.52±3.02 51.79±14.48 0.15±0.05 0.44±0.15 t — 3.93 5.25 8.95 2.48 P — < 0.01 < 0.01 < 0.01 < 0.05 -
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