Analysis of CT Differential Diagnosis of Esophageal and Gastric Syndromes with Different Pathological Types
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摘要: 目的：探究食管胃结合部癌病理型别的能谱CT鉴别诊断效果。方法：回顾性分析2015年1月至2018年1月期间我院收治的116例食管胃结合部癌患者的临床资料，其中64例为腺癌，52例为鳞癌。高分化27例，中分化45例，低分化44例。所有患者均行能谱CT扫描。比较腺癌和鳞癌患者动脉期和静脉期肿块内统一ROI碘浓度（IC）、有效原子序数（Eff-Z）、水浓度（WC）、能谱曲线斜率（λHU），并比较不同分化程度患者动脉期和静脉期肿块内IC、Eff-Z、WC、λHU。分析能谱CT对食管胃结合部癌病理型别和分化程度的鉴别诊断效能。对腺癌和鳞癌患者动脉期和静脉期能谱CT的IC、Eff-Z、WC、λHU比较，结果：①两组患者动脉期和静脉期的WC比较差异无统计学意义（P>0.05）。②两组患者动脉期和静脉期的IC、Eff-Z、λHU比较差异具有统计学意义（P<0.05），腺癌患者动脉期和静脉期的IC、Eff-Z、λHU均高于鳞癌患者。静脉期IC、Eff-Z、λHU具有较高的诊断效能，静脉期Eff-Z诊断效能最佳，AUC为0.97，以8.72为阈值时，鉴别敏感度为88.90％，特异度为94.70％。结论：能谱CT多参数定量分析对食管胃结合部癌病理类型具有较高的诊断价值。Abstract: Objective: To explore the differential diagnosis effect of energy spectrum on the pathological type of esophagogastric junction cancer. Methods: We retrospectively analyzed the clinical data of 116 patients with esophageal and gastric adenocarcinoma who were admitted to our hospital between January 2015 and January 2018. Of these patients, 64 were adenocarcinomas and 52 patients were squamous cell carcinomas. There were 27 well-differentiated cases, 45 moderately differentiated and 44 poorly differentiated. All patients underwent spectral CT scans. The ROI iodine concentration (IC), effective atomic number (Eff-Z), water concentration (WC), energy spectrum curve slope (λHU) in arterial and venous masses were compared between adenocarcinoma and squamous cell carcinoma patients, and the degree of differentiation was compared. In patients with arterial and venous masses, IC, Eff-Z, WC, and λHU. Analyze the differential diagnosis efficacy of energy spectrum CT on the pathological type and differentiation of esophageal and gastric junction cancer. Results: The comparison of IC, Eff-Z, WC, and λHU in the arterial and venous phases of adenocarcinoma and squamous cell carcinoma was performed. Results: (1) There was no significant difference in WC between arterial phase and venous phase in the two groups of patients. (P>0.05); (2) Compared IC, Eff-Z, and λHU in arterial phase and venous phase between the two groups of patients were statistically significant (P<0.05), IC and Eff-Z in arterial phase and venous phase in adenocarcinoma patients. λHU were higher than squamous cell carcinoma patients. The venous phase IC, Eff-Z, and λHU had higher diagnostic efficacy. Eff-Z had the best diagnostic performance at the venous phase. The AUC was 0.97. With 8.72 as the threshold, the differential sensitivity was 88.90% and the specificity was 94.70%. Conclusion: Quantitative analysis of multi-parameters of energy spectrum CT has certain diagnostic value for differentiation of esophagogastric junction cancer.
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