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在所有常见的恶性肿瘤中,结直肠癌在男性病人中排名第三,女性病人中排名第二[1]。由于结直肠癌的初期病症并不是很明显,病人常常难以发觉,就诊时已经是中晚期,严重影响病人的预后, 结直肠癌已经成为严重影响我国人民健康的主要恶性肿瘤之一[2]。影响结直肠癌预后的因素有很多,例如TNM分期、肿瘤生长部位、术前肠梗阻情况等,其中结直肠癌分化程度也是影响病人预后的重要因素[3]。能谱CT采用最新的软硬件及技术,在大肠癌的TNM分期等方面已有不少研究,并且在临床诊疗中发挥极大的作用,具有不可估量的潜力[4-6], 但是在大肠癌分化程度中却很少有人探究。本研究旨在利用能谱CT分析不同分化程度结直肠癌中各能谱参数间的差异,从而可以术前评估结直肠癌病人的分化程度,帮助临床提供更精准的医学信息,更好地评价及预测病人的预后情况。
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2组性别、年龄、肿瘤生长部位、T分期差异均无统计学意义(P>0.05),低分化组肿瘤的淋巴结转移高于中高分化组(P < 0.05)(见表 1)。2组动脉期IC、NIC、水浓度、Eff-Z、K及静脉期水浓度、Eff-Z差异均无统计学意义(P>0.05), 低分化组静脉期IC、NIC、K均高于中高分化组(P < 0.05)(见表 2、3)。
分组 n 男 女 年龄/岁 部位 T分期 淋巴结转移 ≥65 < 65 左半结肠 右半结肠 直肠 T1+T2 T3+T4 是 否 低分化组 18 10 8 8 10 5 7 6 2 16 12 6 中高分化组 32 16 16 19 13 9 11 12 7 25 11 21 χ2 — 0.14 1.03 0.12 0.32 4.84 P — >0.05 >0.05 >0.05 >0.05 < 0.05 表 1 结直肠癌低分化组与中高分化组临床病理特征比较(n)
分组 n IC/(100 μg/mL) NIC 水浓度/(mg/mL) Eff-Z K 低分化组 18 16.28 ±2.45 0.19 ±0.04 1 032.33±4.87 8.51 ±0.23 1.97±0.44 中高分化组 32 15.54 ±3.92 0.17±0.04 1 033.49±10.91 8.50 ±0.2 1.83±0.48 t — 0.72 1.77 0.43 0.10 1.01 P — >0.05 >0.05 >0.05 >0.05 >0.05 表 2 动脉期结直肠癌低分化组与中高分化组能谱参数比较(x±s)
分组 n IC/(100 μg/mL) NIC 水浓度/(mg/mL) Eff-Z K 低分化组 18 20.02±2.09 0.62 ±0.82 1 035.16±4.39 8.7 ±0.17 2.37±0.27 中高分化组 20 18.87 ±3.59 0.50±0.11 1 033.89±5.27 8.66±0.21 2.04±0.46 t — 2.32 4.01 0.87 0.55 2.58 P — < 0.05 < 0.05 >0.05 >0.05 < 0.05 表 3 静脉期结直肠癌低分化组与中高分化组能谱参数比较(x±s)
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静脉期IC、NIC、K诊断结直肠癌分化程度的曲线下面积(AUC)(95%CI)分别为0.77(0.64~0.90)、0.81(0.69~0.93)、0.79(0.66~0.92),当静脉期IC的阈值为18.31(100 μg/mL)时,敏感度和特异度分别为88.3%、62.5%;当静脉期NIC诊断临界值为0.56时,敏感度和特异度分别为83.3%、75.0%;当静脉期K阈值为2.07,敏感性和特异度为88.9%、68.7%。
能谱CT在结直肠癌分化程度中的应用价值研究
Aapplication value of spectral CT in the evaluation of the differentiation degree of colorectal cancer
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摘要:
目的研究256排Revolution能谱CT各参数在结直肠癌分化程度中的应用价值。 方法选取50例通过肠镜或病理确诊的结直肠癌病人,于手术前行GSI能谱CT平扫及双期扫描,通过GSI Viewer软件获得相关能谱图像,并在病灶内勾画出合适的感兴趣区,测量病灶的碘基值(IC)、水浓度、有效原子序数(Eff-Z)、标准化碘浓度(NIC)及能谱曲线斜率(K)。根据病理结果,将50例病人分为低分化组与中高分化组,比较2组各能谱参数,并采用ROC曲线分析各能谱参数的诊断能力。 结果50例病人中高分化组32例,低分化组18例。低分化组肿瘤的淋巴结转移高于中高分化组(P < 0.05)。2组动脉期IC、NIC、水浓度、Eff-Z、K及静脉期水浓度、Eff-Z差异均无统计学意义(P>0.05),低分化组静脉期IC、NIC、K均高于中高分化组(P < 0.05)。静脉期IC、NIC、K诊断结直肠癌分化程度的曲线下面积分别为0.77、0.81、0.79,诊断阈值分别为18.31、0.56、2.07,敏感性分别为88.3%、83.3%、88.9%,特异性分别为62.5%、75.0%、68.7%。 结论能谱CT参数IC、NIC以及K在结直肠癌分化程度中有较高的应用价值。 -
关键词:
- 结直肠肿瘤 /
- 体层摄影术,X线计算机 /
- 能谱成像 /
- 病理分级
Abstract:ObjectiveTo investigate the application value of each parameter of 256-row Revolution spectral CT in evaluating the differentiation degree of colorectal cancer. MethodsFifty patients with colorectal cancer diagnosed by colonoscopy or pathology were selected, and detected using the GSI spectral CT plain scan and dual-phase scan before surgery.The relevant spectral images were obtained through GSI Viewer software, the appropriate region of interest was delineated in the lesion, and the iodine base value(IC), water concentration, effective atomic number(Eff-Z), normalized iodine concentration(NIC) and energy spectral slope(K) of the lesion were measured.According to the pathological results, 50 patients were divided into the low differentiation group and middle-high differentiation group.The spectral parameters were compared between two groups, and the diagnostic ability of each spectral parameter were analyzed using the receiver operating characteristic curve. ResultsAmong 50 patients, 32 cases in middle-high differentiation group and 18 cases in low differentiation group were identified.The lymph node metastasis in low differentiation group was higher than that in middle-high differentiation group(P < 0.05).There was no statistical significance in the IC, NIC, water concentration, Eff-Z and K of arterial phase, and water concentration and Eff-Z of venous phase between two groups(P>0.05).The IC, NIC and K of venous phase in low differentiation group were higher than those in middle-high differentiation group(P < 0.05).The area under the curve, diagnostic threshold, sensitivity and specificity of venous phase IC, NIC, and K were (0.77, 0.81 and 0.79), (18.31, 0.56 and 2.07), (88.3%, 83.3% and 88.9%) and (62.5%, 75.0% and 68.7%), respectively. ConclusionsThe parameters IC, NIC and K of spectral CT have high values in evaluating the differentiation of colorectal cancer. -
表 1 结直肠癌低分化组与中高分化组临床病理特征比较(n)
分组 n 男 女 年龄/岁 部位 T分期 淋巴结转移 ≥65 < 65 左半结肠 右半结肠 直肠 T1+T2 T3+T4 是 否 低分化组 18 10 8 8 10 5 7 6 2 16 12 6 中高分化组 32 16 16 19 13 9 11 12 7 25 11 21 χ2 — 0.14 1.03 0.12 0.32 4.84 P — >0.05 >0.05 >0.05 >0.05 < 0.05 表 2 动脉期结直肠癌低分化组与中高分化组能谱参数比较(x±s)
分组 n IC/(100 μg/mL) NIC 水浓度/(mg/mL) Eff-Z K 低分化组 18 16.28 ±2.45 0.19 ±0.04 1 032.33±4.87 8.51 ±0.23 1.97±0.44 中高分化组 32 15.54 ±3.92 0.17±0.04 1 033.49±10.91 8.50 ±0.2 1.83±0.48 t — 0.72 1.77 0.43 0.10 1.01 P — >0.05 >0.05 >0.05 >0.05 >0.05 表 3 静脉期结直肠癌低分化组与中高分化组能谱参数比较(x±s)
分组 n IC/(100 μg/mL) NIC 水浓度/(mg/mL) Eff-Z K 低分化组 18 20.02±2.09 0.62 ±0.82 1 035.16±4.39 8.7 ±0.17 2.37±0.27 中高分化组 20 18.87 ±3.59 0.50±0.11 1 033.89±5.27 8.66±0.21 2.04±0.46 t — 2.32 4.01 0.87 0.55 2.58 P — < 0.05 < 0.05 >0.05 >0.05 < 0.05 -
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