本文選題：體層攝影術(shù) + X線計算機(jī)　； 參考：《放射學(xué)實(shí)踐》2017年04期

【摘要】：目的:探討CT能譜成像(GSI)在評估胃腺癌分化程度中的應(yīng)用價值。方法:87例經(jīng)手術(shù)病理證實(shí)的胃腺癌患者,術(shù)前均行寶石CT能譜成像雙期增強(qiáng)掃描,通過GSI Viewer分析軟件獲得病灶的能譜曲線,分別計算40~70、70~140及40~140keV各能量區(qū)間的能譜曲線斜率。同時測量病灶的碘濃度,并計算標(biāo)準(zhǔn)化碘濃度(病灶碘濃度與同層腹主動脈碘濃度的比值)。根據(jù)病理分化程度將患者分為中高分化組(36例)和低分化組(51例),采用t檢驗(yàn)比較兩組間能譜參數(shù)的差異。結(jié)果:動脈期:低分化腺癌和中高分化腺癌在40~70、70~140及40~140keV能量區(qū)間的斜率分別為2.89±0.74和2.04±0.41(P=0.001);0.41±0.12和0.28±0.08(P=0.004);1.15±0.30和0.81±0.17(P=0.001)。靜脈期:2組病變在3個能量區(qū)間的斜率分別為5.28±1.23和3.73±0.65(P=0.000);0.79±0.20和0.53±0.12(P=0.001);2.13±0.51和1.49±0.28(P=0.000)。低分化腺癌的能譜曲線斜率均大于中高分化腺癌。以靜脈期40~70keV能量區(qū)間的能譜曲線斜率的AUC(0.887)最大,以曲線斜率k=4.60作為閾值時,敏感度為70.6%,特異度為91.7%。動脈期和靜脈期時低分化腺癌的碘濃度和標(biāo)準(zhǔn)化碘濃度比均高于中高分化腺癌,差異均有統(tǒng)計學(xué)意義(P0.01)。以靜脈期標(biāo)準(zhǔn)化碘濃度比的AUC(0.889)最大,以0.458作為診斷閾值時,敏感度為94.1%,特異度為78.3%。結(jié)論:胃腺癌病灶的碘濃度、標(biāo)準(zhǔn)化碘濃度比以及能譜曲線與其組織學(xué)分化程度具有相關(guān)性,CT能譜成像能為術(shù)前評估胃腺癌的分化程度提供新的指標(biāo)。
[Abstract]:Objective: to evaluate the value of CT energy dispersive imaging (GSI) in evaluating the differentiation of gastric adenocarcinoma. Methods 87 cases of gastric adenocarcinoma confirmed by operation and pathology were examined by double phase enhanced scanning with gemstone CT energy spectrum imaging before operation. The spectral curves of the lesions were obtained by GSI Viewer analysis software, and the slope of the energy spectrum curves of 40 ~ 7070 ~ 70 ~ 70 ~ 140 Kev and 40 ~ 140 Kev energy intervals were calculated respectively. At the same time, the iodine concentration of the lesion was measured, and the standardized iodine concentration (the ratio of the iodine concentration of the lesion to the iodine concentration of the same layer of abdominal aorta) was calculated. According to the degree of pathological differentiation, the patients were divided into middle and high differentiation group (36 cases) and low differentiation group (51 cases). T test was used to compare the difference of energy spectrum parameters between the two groups. Results: in arterial phase, the slope of low-differentiated adenocarcinoma and well-differentiated adenocarcinoma were 2.89 鹵0.74 and 2.04 鹵0.41 (P0. 001) 0.41 鹵0. 12 and 0. 28 鹵0. 08 (P0. 004), 1.15 鹵0. 30 and 0. 81 鹵0. 17 (P0. 001), respectively. The slope of the lesions in the venous phase: group 2 was 5.28 鹵1.23 and 3.73 鹵0.65 (P0. 000), 0.79 鹵0. 20 and 0. 53 鹵0. 12 (P0. 001), 2.13 鹵0. 51 and 1. 49 鹵0. 28 (P0. 000), respectively. The slope of energy spectrum curve of low differentiated adenocarcinoma was higher than that of middle and high differentiated adenocarcinoma. The maximum value of AUC _ (0.887) was obtained from the energy interval of 40 ~ 70keV in vein phase. The sensitivity and specificity were 70.6 and 91.7 when the curve slope was 4.60 and the sensitivity was 70.6 and the specificity was 91.7%. The iodine concentration and standardized iodine concentration ratio in poorly differentiated adenocarcinoma were significantly higher than those in well-differentiated adenocarcinoma at arterial and venous stages (P0.01). AUC _ (0.889) with standardized iodine concentration ratio in venous phase was the largest. When the diagnostic threshold was 0.458, the sensitivity was 94.1 and the specificity was 78.3. Conclusion: the iodine concentration, standardized iodine concentration ratio and energy spectrum curve of gastric adenocarcinoma lesions are correlated with the histological differentiation degree. EDS can provide a new index for preoperative evaluation of gastric adenocarcinoma differentiation.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院放射科;
【基金】：國家自然科學(xué)基金面上項(xiàng)目(81271573)
【分類號】：R730.44;R735.2

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