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

doi:10.15953/j.ctta.2022.231

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

杨振兴^1a,,
张宇琦²,
刘挨师^1a,
吴慧^1a,
赵磊^1a,
高伟^1a,
施琳^1b,
郝粉娥^1a, ,

1.
影像诊断科内蒙古医科大学附属医院
2.
病理科，呼和浩特010050 内蒙古医科大学附属医院
2.
内蒙古医科大学第一临床医学院, 呼和浩特010110

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∗，

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出版历程
- 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

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

YANG Zhenxing^{1a
,},
ZHANG Yuqi²,
LIU Aishi^1a,
WU Hui^1a,
ZHAO Lei^1a,
GAO Wei^1a,
SHI Lin^1b,
HAO Fene^{1a
, ,}

1.
The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China Department of Imaging Diagnosis
2.
The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China Department of Pathology
2.
The First Clinical College of Inner Mongolia Medical University, Hohhot 010110, China

摘要

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。
- 双源CT /
- 双能量虚拟平扫 /
- 直肠癌 /
- 壁外血管侵犯
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.
- dual-source CT /
- dual-energy virtual non-contrast /
- rectal cancer /
- extramural vascular invasion

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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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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
项目	阳性（n=56）	阴性（n=94）	P
年龄/岁	52.56	58.47	0.342
性别
男	35	51	0.478
女	21	43	0.478
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％）	0.000
伴远处转移
阳性	35（62.5％）	14（14.9％）	0.031
阴性	21（37.5％）	80（85.1％）	0.031
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
双源CT双能量虚拟平扫诊断结果	EMVI阳性（n=56）	EMVI阴性（n=94）	合计
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。

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
双源CT双能量虚拟平扫诊断结果	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	0.912	0.000

下载: 导出CSV

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