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双源CT双能量虚拟平扫对直肠癌壁外血管侵犯的诊断价值

杨振兴 张宇琦 刘挨师 吴慧 赵磊 高伟 施琳 郝粉娥

杨振兴, 张宇琦, 刘挨师, 等. 双源CT双能量虚拟平扫对直肠癌壁外血管侵犯的诊断价值[J]. CT理论与应用研究, 2023, 32(0): 1-7. DOI: 10.15953/j.ctta.2022.231
引用本文: 杨振兴, 张宇琦, 刘挨师, 等. 双源CT双能量虚拟平扫对直肠癌壁外血管侵犯的诊断价值[J]. CT理论与应用研究, 2023, 32(0): 1-7. DOI: 10.15953/j.ctta.2022.231
YANG Z X, ZHANG Y Q, LIU A S, et al. Diagnostic Value of Dual-source CT Dual-energy Virtual Non-contrasting Extramural Vascular Invasions of Rectal Cancer[J]. CT Theory and Applications, 2023, 32(0): 1-7. DOI: 10.15953/j.ctta.2022.231. (in Chinese)
Citation: YANG Z X, ZHANG Y Q, LIU A S, et al. Diagnostic Value of Dual-source CT Dual-energy Virtual Non-contrasting Extramural Vascular Invasions of Rectal Cancer[J]. CT Theory and Applications, 2023, 32(0): 1-7. DOI: 10.15953/j.ctta.2022.231. (in Chinese)

双源CT双能量虚拟平扫对直肠癌壁外血管侵犯的诊断价值

doi: 10.15953/j.ctta.2022.231
基金项目: 内蒙古自治区自然科学基金(双源双能量CT对直肠癌壁外血管侵犯的诊断价值研究(2020MS08051));内蒙古自治区高等学校科学研究项目(双能CT小肠造影对炎症性肠病(IBD)的诊断价值研究(NJZY22668));内蒙古医科大学联合项目(基于双能CT结直肠癌区域淋巴结转移危险因素分析与预测模型构建研究(YKD2022LH020));内蒙古医科大学附属医院青年骨干项目(双能CT定量参数对结直肠癌和炎症性结直肠壁局限性增厚的鉴别诊断价值(2022NYFYFG025));内蒙古医科大学青年培育项目(双源CT双能量碘图评估直肠癌脉管侵犯的可行性分析(YKD2022QN019));内蒙古医科大学“三位一体”大学生创新创业培育项目(双能量CT成像技术对直肠癌壁外血管侵犯的诊断价值研究(SWYT2021036))。
详细信息
    作者简介:

    杨振兴:男,医学硕士,内蒙古医科大学附属医院影像诊断科主治医师,主要从事医学影像学诊断工作,E-mail:492608424@qq.com

    郝粉娥:女,医学硕士,内蒙古医科大学附属医院影像诊断科主任医师、硕士研究生导师,E-mail:hfe1022@163.com

    通讯作者:

    郝粉娥∗,

Diagnostic Value of Dual-source CT Dual-energy Virtual Non-contrasting Extramural Vascular Invasions of Rectal Cancer

  • 摘要: 目的:探讨双源CT双能量虚拟平扫(VNC)对直肠癌壁外血管侵犯(EMVI)的术前诊断价值。方法:选取我院2019年11月至2021年12月间拟手术治疗的150例直肠癌患者术前行双源CT双能量虚拟平扫,女性64例(42.7%)、男性86例(57.3%),平均年龄为(62.3±11.8)岁。2名高年资影像科医师独立分析术前影像资料(包括ctEMVI情况及有无局部淋巴结浸润和远处转移)判断是否存在术前EMVI。以手术病理结果为金标准,分别评价VNC诊断EMVI的敏感性、特异性、准确性、阳性预测值和阴性预测值并采用受试者操作特征(ROC)曲线下面积评价其诊断效能。结果:150例直肠癌患者中,术后病理证实56例(37.3%)为EMVI阳性,94例(62.7%)为EMVI阴性。医师1对EMVI评价准确性、敏感性、特异性、阳性预测值、阴性预测值分别为86%、80.36%、89.36%、81.82%、88.42%,AUC为0.831(95%CI 0.756~0.905);医师2的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为88.67%、80.36%、93.62%、88.24%、88.89%,AUC为0.870(95%CI 0.802~0.938),医师1与医师2的评估结果一致性较高(k=0.943,P<0.05)。结论:双源CT双能量虚拟平扫对直肠癌EMVI术前评估具有一定的诊断价值。

     

  • 图  2  医师1、医师2评估EMVI-ROC曲线

    Figure  2.  The EMVI-ROC curve evaluated by physicians 1 and 2

    图  1  患者男79岁,直肠癌壁外血管侵犯

    Figure  1.  A 79-year-old male patient with extravascular invasion of rectal cancer

    表  1  150例直肠癌患者的一般资料

    Table  1.   General data of 150 patients with rectal cancer

    项目ctEMVIP
    阳性(n=56)阴性(n=94)
    年龄/岁 52.5658.470.342
    性别      
    男   35510.478
    女   2143
    伴局部淋巴结浸润
    阳性  37(66.1%)58(61.7%)0.000
    阴性  19(33.9%)36(38.3%)
    伴远处转移   
    阳性  35(62.5%)14(14.9%)0.031
    阴性  21(37.5%)80(85.1%)
     注:局部淋巴结浸润、远处淋巴结转移对EMVI阴阳性诊断具有统计学意义,P<0.05。
    下载: 导出CSV

    表  2  单纯ctEMVI与ctEMVI结合局部淋巴结浸润、远处转移诊断EMVI准确率比较

    Table  2.   Comparison of the accuracy of ctEMVI alone and ctEMVI combined with local lymph node invasion and distant metastasis in the diagnosis of EMVI

    双源CT双能量虚拟平扫诊断结果病理学诊断结果合计
    EMVI阳性(n=56)EMVI阴性(n=94)
    单纯ctEMVI诊断例数            41109150
    ctEMVI结合局部淋巴结浸润、远处转移诊断例数45105150
     注:当ctEMVI表现结合局部淋巴结浸润和/或远处转移较单纯ctEMVI表现诊断准确率有所提高。
    下载: 导出CSV

    表  3  两位影像医师评估ctEMVI情况记录表

    Table  3.   Two radiologists evaluated the ctEMVI records

    双源CT双能量虚拟平扫诊断结果医师1医师2统计检验
    例数百分比/%例数百分比/%kP
    ctEMVI阴性9563.339966.000.9120.000
    ctEMVI阳性5536.675134.00
    下载: 导出CSV
  • [1] SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA-A Cancer Journal for Clinicians, 2021, 71(3): 209−249. DOI: 10.3322/caac.21660.
    [2] CHER H T, RAGHUNANDAN V, PIYAPORN B, et al. Extramural venous invasion by gastrointestinal malignancies: CT appearances[J]. Abdominal Imaging, 2011, 36(5): 491−502. DOI: 10.1007/s00261-010-9667-8.
    [3] CHAND M, BHODAY J, BHOME R, et al. mrEMVI status should be used in addition to pEMVI for treatment decision making in rectal cancer to prevent under-reporting of extramural venous invasion[J]. European Journal of Surgical Oncology, 2013, 39(2): 66−79.
    [4] PRAMPOLINIF, TASCHINIS, PECCHI, et al. Magnetic resonance imaging performed before and after preoperative chemoradiotherapy chemoradiotherapy in rectal cancer: Predictive factors of recurrence and prognostic significance of MR-detected extramural venous invasion[J]. Abdominal Radiology, 2020, 45(10): 2941−2949. DOI: 10.1007/s00261-018-1838-z.
    [5] MASSUCCO P, FONTANA A P, BALBO M A, et al. MRI-detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer[J]. Journal of surgical oncology, 2022, 125(6): 1024−1031. DOI: 10.1002/jso.26818.
    [6] TAE H K, SUNGMIN W, SANGWON H, et al. The diagnostic performance of MRI for detection of extramural venous invasion in colorectal cancer: a systematic review and meta-analysis of the literature[J]. American Journal of Roentgenology, 2019, 213(3): 575−585. DOI: 10.2214/AJR.19.21112.
    [7] TRIVEDI H, CHAMARTHY U, DICARLO L, et al. Prognostic factors of overall survival for patients with stage II colon cancer[J]. Acta Medica Academiae Scientiarum Hungaricae, 2014, 43(2): 134−143. DOI: 10.5644/ama2006-124.112.
    [8] 白晨. 基于高分辨率MRI影像组学方法直肠癌EMVI诊断模型的研究[D]. 长春: 吉林大学, 2022.

    BAI C. study of extramural venous invasion diagnostic model for rectal cancer based on high-resolution MRI radiomics method[D]. Changchun: Jilin University, 2022. DOI: 10. 27162/d. cnki. gjlin. 2022. 007006. (in Chinese).
    [9] 中国结直肠癌诊疗规范(2020年版)[J]. 中国实用外科杂志, 2020, 40(6): 601-625.

    Chinese protocol of diagnosis and treatment of colorectal cancer(2020 edition)[J]. Chinese Journal of Practical Surgery, 2020, 40(6): 601-625. DOI:10.19538/j.cjps.issn1005-2208.2020.06.01. (in Chinese).
    [10] BENSON A B, III, VENOOK A P, AL-HAWARY M M, et al. Rectal cancer, version 2.2018 clinical practice guidelines in oncology[J]. Journal of the National Comprehensive Cancer Network, 2018, 16(7): 874−901. DOI: 10.6004/jnccn.2018.0061.
    [11] 唐雪, 江长思, 张世派, 等. 直肠MR造影对直肠癌壁外血管侵犯的诊断价值[J]. 医学影像学杂志, 2022,32(4): 638−642. DOI: 10.3969/j.issn.1006-9011.2022.4.yxyxxzz202204027.

    TANG X, JIANG C S, ZHANG S P, et al. Diagnosis value of MR rectography in assessment for extravasational vascular invasion of rectal cancers[J]. Journal of Medical Imaging, 2022, 32(4): 638−642. DOI: 10.3969/j.issn.1006-9011.2022.4.yxyxxzz202204027. (in Chinese).
    [12] 路凯, 兰国宾, 戴士林. 双源CT双能量虚拟平扫对结直肠良恶性肿瘤的鉴别诊断价值研究[J]. 中国CT和MRI杂志, 2021,19(9): 131−134. DOI: 10.3969/j.issn.1672-5131.2021.09.042.

    LU K, LAN G B, DAI S L. Differential diagnosis value of dual-source CT dual-energy virtual non-contrast on benign and malignant colorectal tumors[J]. Chinese Journal of CT and MRI, 2021, 19(9): 131−134. DOI: 10.3969/j.issn.1672-5131.2021.09.042. (in Chinese).
    [13] ZHEN G, ZHANG X Y, LI X T, et al. Correlation and prognostic value of CT-detected extramural venous invasion and pathological lymph-vascular invasion in colon cancer[J]. Abdominal Radiology, 2022, 47(4): 1232−1243. DOI: 10.1007/s00261-022-03414-7.
    [14] TRIPATHI P, GUO W, RAO S, et al. Additional value of MRI-detected EMVI scoring system in rectal cancer: Applicability in predicting synchronous metastasis[J]. Tumori Journal, 2020, 106(4): 286−294. DOI: 10.1177/0300891620901745.
    [15] TRIPATHI P, RAO S X, ZENG M S. Clinical value of MRI-detected extramural venous invasion in rectal cancer[J]. Journal of Digestive Diseases, 2017, 18(1): 2−12. DOI: 10.1111/1751-2980.12439.
    [16] BRUCE M, JENNIFER S. Somatostatin receptor scintigraphy of neuroendocrine tumors of the abdomen and pelvis[J]. Seminars in Roentgenology, 2016, 51(2): 112−122. DOI: 10.1053/j.ro.2016.02.008.
    [17] 虞云杰, 陈孝娟, 李鹏, 等. 多层螺旋CT在直肠癌术前诊断及⾎管侵犯评估中的应⽤价值[J]. 中国CT和MRI杂志, 2020,18(2): 117−120. DOI: 10.3969/j.issn.1672-5131.2020.02.035.

    YU Y J, CHEN X J, LI P, et al. Application value of multi-slice spiral CT in the preoperative diagnosis of rectal cancer and assessment of vascular invasion[J]. Chinese Journal of CT and MRI, 2020, 18(2): 117−120. DOI: 10.3969/j.issn.1672-5131.2020.02.035. (in Chinese).
    [18] SOHN B, LIM J S, KIM H, et al. MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer[J]. European Radiology, 2015, 25(5): 1347−1355. DOI: 10.1007/s00330-014-3527-9.
    [19] CHAND M, EVANS J, SWIFT R I, et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer[J]. Annals of Surgery, 2015, 261(3): 473−479. DOI: 10.1097/SLA.0000000000000848.
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  • 收稿日期:  2022-11-21
  • 修回日期:  2023-01-07
  • 录用日期:  2023-01-07
  • 网络出版日期:  2023-02-22

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