一站式CT能谱灌注成像预测兔腋窝淋巴结性质
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摘要
目的探讨一站式CT能谱灌注成像定量参数预测兔腋窝淋巴结性质的应用价值。方法将60只新西兰纯种雌性大白兔随机分为2组,分别建立兔乳腺癌腋窝转移性淋巴结(转移组)与炎性淋巴结动物模型(炎症组)。于建模后第4周末对实验兔行一站式CT能谱灌注成像扫描,扫描完成后摘取腋窝淋巴结行病理检查,并与CT图像逐一对照。采用两独立样本t检验比较2组能谱参数和灌注参数的差异,以Logistic回归和ROC曲线分析单一参数和联合参数诊断实验兔腋窝淋巴结性质的效能。结果转移组淋巴结的血流量(BF)、血容量(BV)、动静脉期碘浓度(IC)、标准化碘基值(NIC)和40～70keV间的能谱曲线斜率(λ)均高于炎症组(P均<0.05),平均通过时间(MTT)和表面通透性(PS)差异无统计学意义(P均>0.05)。最佳联合参数(BF+动脉期λ+静脉期λ)的AUC为0.942,以0.65为临界值,其诊断实验兔腋窝乳腺癌转移性淋巴结的敏感度、特异度、阳性预测值和阴性预测值分别为79.68%、95.92%、92.91%和82.70%。结论一站式CT能谱灌注成像定量参数鉴别兔腋窝乳腺癌转移性淋巴结与炎性淋巴结的诊断效能较好,联合参数(BF+动脉期λ+静脉期λ)具有较高诊断价值。
Objective To explore the application value of one-stop CT gemstone spectral and perfusion imaging quantitative parameters in predicting the properties of axillary lymph nodes.Methods Totally 60 purebred female New Zealand white rabbits were randomly divided into two groups,and rabbit models of axillary metastatic lymph nodes with VX2 implanted breast cancer(metastasis group)and inflammatory lymph nodes(inflammation group)were established,respectively.One-stop CT gemstone spectral and perfusion imaging scan was performed at the end of the fourth week after modeling.Then the axillary lymph nodes were taken for pathological examination and compared with CT images.Two independent samples t-test were used to compare the energy parameters and perfusion parameters between metastatic and inflammatory lymph nodes.Logistic regression and ROC curves were used to analyze the efficacy of single parameters and combined parameters in diagnosis of rabbit axillary lymph nodes.Results The blood flow(BF),blood volume(BV),arteriovenous iodine concentration(IC),standardized iodine value(NIC)and the slope(λ)of the energy spectrum curve from40 keV to 70 keV in the metastasis group were higher than those in inflammation group(all P<0.05).There was no significant difference in mean transit time(MTT)and surface permeability(PS)between two groups(both P>0.05).Taken 0.65 as the threshold,AUC of combined parameters(BF+arterial phaseλ+venous phaseλ)was 0.942,the sensitivity,specificity,positive predictive value and negative predictive value in diagnosis of axillary lympy nodes were 79.68%,95.92%,92.91%and 82.70%,respectively.Conclusion The quantitative parameters of one-stop CT gemstone spectral and perfusion imaging show good diagnostic efficacy in identifying rabbit axillary breast cancer metastatic lymph nodes and inflammatory lymph nodes,while combined parameters(BF+arterial phaseλ+venous phaseλ)have higher diagnostic value.
Objective To explore the application value of one-stop CT gemstone spectral and perfusion imaging quantitative parameters in predicting the properties of axillary lymph nodes.Methods Totally 60 purebred female New Zealand white rabbits were randomly divided into two groups,and rabbit models of axillary metastatic lymph nodes with VX2 implanted breast cancer(metastasis group)and inflammatory lymph nodes(inflammation group)were established,respectively.One-stop CT gemstone spectral and perfusion imaging scan was performed at the end of the fourth week after modeling.Then the axillary lymph nodes were taken for pathological examination and compared with CT images.Two independent samples t-test were used to compare the energy parameters and perfusion parameters between metastatic and inflammatory lymph nodes.Logistic regression and ROC curves were used to analyze the efficacy of single parameters and combined parameters in diagnosis of rabbit axillary lymph nodes.Results The blood flow(BF),blood volume(BV),arteriovenous iodine concentration(IC),standardized iodine value(NIC)and the slope(λ)of the energy spectrum curve from40 keV to 70 keV in the metastasis group were higher than those in inflammation group(all P<0.05).There was no significant difference in mean transit time(MTT)and surface permeability(PS)between two groups(both P>0.05).Taken 0.65 as the threshold,AUC of combined parameters(BF+arterial phaseλ+venous phaseλ)was 0.942,the sensitivity,specificity,positive predictive value and negative predictive value in diagnosis of axillary lympy nodes were 79.68%,95.92%,92.91%and 82.70%,respectively.Conclusion The quantitative parameters of one-stop CT gemstone spectral and perfusion imaging show good diagnostic efficacy in identifying rabbit axillary breast cancer metastatic lymph nodes and inflammatory lymph nodes,while combined parameters(BF+arterial phaseλ+venous phaseλ)have higher diagnostic value.
引文
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[6]李青青,杨斌,柯腾飞,等.能谱成像技术诊断颈部甲癌转移淋巴结、鳞癌转移淋巴结及淋巴瘤.实用放射学杂志,2015,31(5):740-743,758.
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[10] Eastwood JD,Lev MH,Azhari T,et al.CT perfusion scanning with deconvolution analysis:Pilot study in patients with acute middle cerebral artery stroke. Radiology,2002,222(1):227-236.
[11] Liu XW,Ouyang D,Li H,et al.Papillary thyroid cancer:Dual-energy spectral CT quantitative parameters for preoperative diagnosis of metastasis to the cervical lymph nodes.Radiology,2015,275(1):167-176.
[12] Tawfik AM,Razek AA,Kerl JM,et al.Comparison of dualenergy CT-derived iodine content and iodine overlay of normal,inflammatory and metastatic squamous cell carcinoma cervical lymph nodes.Eur Radiol,2014,24(3):574-580.
[13] Tang L,Li ZY,Li ZW,et al.Evaluating the response of gastric carcinomastoneoadjuvantchemotherapyusingiodine concentration on spectral CT:A comparison with pathological regression.Clin Radiol,2015,70(11):1198-1204.
[14]王玉婕,黄遥,唐威,等.宝石能谱CT在提高非小细胞肺癌术前淋巴结转移状态准确性中的初步研究.癌症进展,2015,13(2):188-193.
[15] Liu H,Yan F,Pan Z,et al.Evalution of dual energy spectral CT in differentiating metastatic from non-metastatic lymph nodes in rectal cancer:Initial experience.Eur J Radiol,2015,84(2):228-234.
[2]阎晓朋,吕培杰,柴亚如,等.CT能谱及灌注一站式成像的兔模型实验.中国医学影像技术,2016,32(4):483-486.
[3]王素雅,高剑波,梁盼,等.一站式能谱及灌注成像鉴别诊断孤立性肺结节.实用放射学杂志,2016,32(2):200-203.
[4] Li A,Liang H,Li W,et al.Spectral CT imaging of larngenal and hypophartngeal squamous cell carcinoma:Evaluation of image quality and status of lymph nodes. PLoS One, 2013,8(12):e83492.
[5]杨亮,罗德红,赵燕风,等.能谱参数诊断不同颈部淋巴结病变的价值.医学影像学杂志,2015,25(12):2095-2099.
[6]李青青,杨斌,柯腾飞,等.能谱成像技术诊断颈部甲癌转移淋巴结、鳞癌转移淋巴结及淋巴瘤.实用放射学杂志,2015,31(5):740-743,758.
[7]刘云,丁英奇,孟海霞,等.CT灌注成像评价乳腺癌腋窝淋巴结状态的临床应用价值.中华放射学杂志,2008,42(6):577-581.
[8]廖茜,汪俊萍,白人驹,等.CT灌注成像鉴别兔腋窝淋巴结炎性增生性与转移性淋巴结.中国医学影像技术,2011,27(12):2423-2426.
[9] Hoshida T,Isaka N,Hagendoom J,et al.Imaging steps of lymphatic metastasis reveals that vascular endothelial growth factor-C increases metastasis by increasing delivery of cancer cells to lymph nodes:Therapeutic implication.Cancer Res,2006,66(16):8065-8075.
[10] Eastwood JD,Lev MH,Azhari T,et al.CT perfusion scanning with deconvolution analysis:Pilot study in patients with acute middle cerebral artery stroke. Radiology,2002,222(1):227-236.
[11] Liu XW,Ouyang D,Li H,et al.Papillary thyroid cancer:Dual-energy spectral CT quantitative parameters for preoperative diagnosis of metastasis to the cervical lymph nodes.Radiology,2015,275(1):167-176.
[12] Tawfik AM,Razek AA,Kerl JM,et al.Comparison of dualenergy CT-derived iodine content and iodine overlay of normal,inflammatory and metastatic squamous cell carcinoma cervical lymph nodes.Eur Radiol,2014,24(3):574-580.
[13] Tang L,Li ZY,Li ZW,et al.Evaluating the response of gastric carcinomastoneoadjuvantchemotherapyusingiodine concentration on spectral CT:A comparison with pathological regression.Clin Radiol,2015,70(11):1198-1204.
[14]王玉婕,黄遥,唐威,等.宝石能谱CT在提高非小细胞肺癌术前淋巴结转移状态准确性中的初步研究.癌症进展,2015,13(2):188-193.
[15] Liu H,Yan F,Pan Z,et al.Evalution of dual energy spectral CT in differentiating metastatic from non-metastatic lymph nodes in rectal cancer:Initial experience.Eur J Radiol,2015,84(2):228-234.