肿瘤原发灶和最大瘤周结节的能谱CT参数预测结直肠癌肿瘤沉积的价值研究

Value of dual-energy spectral CT parameters of primary tumor and the largest peritumoral nodule in predicting tumor deposits in colorectal cancer

    摘要
  • 摘要:
    目的 探讨肿瘤原发灶和最大瘤周结节的能谱CT参数预测结直肠癌肿瘤沉积（TDs）的价值。
    方法 回顾性分析2022年3月至2024年5月于惠州市中心人民医院经术后病理证实的121例结直肠癌患者，其中男性64例、女性57例，年龄（64.8±11.4）岁。根据病理结果将患者分为TDs阳性组（33例）和TDs阴性组（88例）。测量结直肠癌肿瘤原发灶和最大瘤周结节的能谱CT参数（包括动、静脉期碘浓度、能谱曲线斜率k）和最大瘤周结节短径。比较两组患者的CT参数和最大瘤周结节短径。符合正态分布的计量资料的组间比较采用两独立样本t检验（方差齐）；不符合正态分布的计量资料的组间比较采用Mann-Whitney U检验；计数资料的组间比较采用χ2检验和秩和检验。分别将动、静脉期CT参数与最大瘤周结节短径纳入二元Logistic回归，建立能谱联合参数模型。采用受试者工作特征（ROC）曲线评价模型的诊断效能，并计算曲线下面积（AUC）。
    结果  TDs阳性组最大瘤周结节的碘浓度、k值均小于TDs阴性组动脉期碘浓度：（15.49（11.56，18.56））×100 ng/cm3对（18.35（14.58，24.08））×100 ng/cm3，动脉期k：1.84（1.39，2.21）对2.17（1.73，2.85），静脉期碘浓度：（20.26±4.35）×100 ng/cm3对（24.06±5.14）×100 ng/cm3，静脉期k：2.40±0.51对2.86±0.61，且差异均有统计学意义（Z=−3.425、−3.416，t=3.767、3.780，均P<0.05）。TDs阳性组肿瘤原发灶的碘浓度、k值，最大瘤周结节短径均大于TDs阴性组动脉期碘浓度：（17.28±3.18）×100 ng/cm3对（15.76±3.61）×100 ng/cm3，动脉期k： 2.05±0.38对1.87±0.43，静脉期碘浓度：（22.64±3.23）×100 ng/cm3对（21.00±2.97）×100 ng/cm3，静脉期k： 2.69±0.39对2.49±0.35，最大瘤周结节短径：7.10（5.55，9.40） mm对6.00（4.83，6.88） mm，且差异均有统计学意义（t=−2.134、−2.186、−2.642、−2.661，Z=−2.664，均P<0.05）。淋巴结转移呈阳性、更高的N分期以及M分期、CEA水平升高的患者出现TDs阳性的风险更高（Z=−3.250、−6.478、−3.215，χ2=5.671，均P<0.05）。ROC曲线分析结果显示，静脉期能谱联合参数预测TDs的效能最佳，其AUC为0.834，临界值为0.303，灵敏度为0.788，特异度为0.761。
    结论 结直肠癌肿瘤原发灶和最大瘤周结节的能谱CT参数对TDs有一定的预测价值，其静脉期联合参数模型的预测效能最佳。

     

    Abstract:
    Objective  To explore the value of spectral CT parameters of primary tumors and largest peritumoral nodules in predicting tumor deposits (TDs) in colorectal cancer(CRC).
    Methods  This retrospective study analyzed 121 pathologically confirmed colorectal cancer patients (64 males, 57 females; mean age 64.8±11.4 years) treated at Huizhou Central People′s Hospital from March 2022 to May 2024. Patients were divided into TDs-positive (n=33) and TDs-negative (n=88) groups based on pathological findings. Spectral CT parameters of primary tumors and largest peritumoral nodules were measured, including iodine concentration (IC) and spectral curve slope (k) in arterial/venous phases, along with the short-axis diameter of the largest peritumoral nodule. CT parameters and nodule short diameter were compared between groups. Two independent sample t test (homogeneity of variance) was used to compare the measurement data in accordance with normal distribution between groups. Mann-Whitney U test was used to compare the measurement data that did not conform to the normal distribution between groups. χ2 test and rank sum test were used for comparison of count data between groups. Binary logistic regression was performed to establish spectral CT combined parameter models using arterial/venous phase parameters and nodule short diameter. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance, and the area under curve (AUC) was calculated.
    Results  The TDs-positive group showed significantly lower IC and k values in the largest peritumoral nodules compared to the TDs-negative group (arterial IC: 15.49 (11.56 18.56)×100 ng/cm3 vs. 18.35 (14.58 24.08)×100 ng/cm3, arterial k: 1.84 (1.39, 2.21) vs. 2.17 (1.73 2.85); venous IC: (20.26±4.35)×100 ng/cm3 vs. (24.06±5.14)×100 ng/cm3, venous k: 2.40±0.51 vs. 2.86±0.61; Z=−3.425, −3.416, t=3.767, 3.780; all P<0.05). Conversely, the TDs-positive group exhibited higher IC and k values in primary tumors and larger nodule short-axis diameters (arterial IC: (17.28±3.18)×100 ng/cm3 vs. (15.76±3.61)×100 ng/cm3, arterial k: 2.05±0.38 vs. 1.87±0.43; venous IC: (22.64±3.23)×100 ng/cm3 vs. (21.00±2.97)×100 ng/cm3, venous k: 2.69±0.39 vs. 2.49±0.35; nodule short-axis: 7.10 (5.55−9.40) mm vs. 6.00 (4.83−6.88) mm; t=−2.134, −2.186, −2.642, −2.661, Z=−2.664; all P<0.05). Patients with lymph node metastasis, higher N/M stages, and elevated CEA levels had increased TDs risk (Z=−3.250, −6.478, −3.215, χ2=5.671; all P<0.05). ROC analysis revealed that the venous-phase combined spectral CT parameters achieved optimal predictive performance for TDs (AUC=0.834, cutoff=0.303, sensitivity=0.788, specificity=0.761).
    Conclusion Spectral CT parameters of the primary tumor and the largest peritumoral nodule in colorectal cancer have predictive value for TDs, with the combined parameter models in the venous phase showing the best predictive performance.

     

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