Diagnostic Value of Dual-source CT Dual-energy Virtual Non-contrasting Extramural Vascular Invasions of Rectal Cancer
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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。Abstract: Objective: To investigate the value of dual-source CT dual-energy virtual plain scan in the preoperative diagnosis of extramural vascular invasion (EMVI) in rectal cancer. Methods: A total of 150 patients with rectal cancer (64 females (42.7%) and 86 males (57.3%), with an average age of (62.3±11.8) years) who were scheduled for surgical treatment in our hospital from November 2019 to December 2021 were selected for the preoperative dual-source CT dual-energy virtual plain scan;. Two senior radiologists independently analyzed preoperative imaging data (including ctEMVI status, local lymph node infiltration, and distant metastasis) to determine the existence of preoperative EMVI. With pathological results as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of VNC in the diagnosis of EMVI were evaluated, and the area under the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency. Results: Among 150 patients with rectal cancer, 56 (37.3%) were positive for EMVI and 94 (62.7%) were negative for EMVI. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of EMVI evaluation by physician 1 were 86%, 80.36%, 89.36%, 81.82%, and 88.42%, respectively, and the AUC was 0.831 (95%CI, 0.756~0.905). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of physician 2 were 88.67%, 80.36%, 93.62%, 88.24%, and 88.89%, respectively, and the AUC was 0.870 (95%CI, 0.802−0.938). The consistency of the evaluation results between physician 1 and physician 2 was high (k=0.943, P<0.05). Conclusion: Dual-source CT dual-energy virtual plain scan has a certain diagnostic value in the preoperative evaluation of EMVI of rectal cancer.
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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 ctEMVI P 阳性(n=56) 阴性(n=94) 年龄/岁 52.56 58.47 0.342 性别 男 35 51 0.478 女 21 43 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。 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 41 109 150 ctEMVI结合局部淋巴结浸润、远处转移诊断例数 45 105 150 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。 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/% k P ctEMVI阴性 95 63.33 99 66.00 0.912 0.000 ctEMVI阳性 55 36.67 51 34.00 -
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