Value of energy spectrum CT parameters in preoperative differentiation of stage T3 and T4a gastric cancer

doi:10.3877/cma.j.issn.2095-2015.2021.06.003

Abstract

Abstract:

Objective

To investigate the value of energy spectrum CT parameters in preoperative differentiation of stage T3 and T4a gastric cancer.

Methods

A total of 52 patients with gastric adenocarcinoma diagnosed by surgical pathology in First Affiliated Hospital of Zhengzhou University from July 2015 to September 2018 were retrospectively analyzed. Among them, 23 cases were stage T3 and 29 cases were stage T4a. The general clinical data, perigastric fat, iodine concentration (IC) value and normalized iodine concentration (nIC) value of patients at T3 and T4a stage were compared. The logistic regression analysis was used to analyzed the independent risk factors of T4a gastric cancer. The receiver operating characteristic (ROC) curve was drawn to evaluate the discrimination efficiency of energy spectrum CT for T4a gastric cancer.

Results

There were significant differences in primary differentiation degree and Borrmann classification between T3 and T4a gastric cancer patients (both P<0.05). The IC value and nIC value of perigastric fat space in arterial and venous phases of T4a gastric cancer patients were higher than those of T3 gastric cancer patients (all P<0.05). Logistic regression analysis showed that IC values in arterial and venous phases were independent risk indexes for T4a gastric cancer (P<0.05). The area under ROC curve (AUC) of IC and nIC value of perigastric fat space in arterial and venous phases were 0.888, 0.850, 0.853 and 0.844, respectively, and the critical value of IC=-10.8 in arterial phase was the best for the diagnosis of T4a stage gastric cancer.

Conclusions

The IC value of perigastric fat space in arterial and venous phases can be used to differentiate T3 and T4a gastric cancer. Abdominal energy spectrum CT can improve the accuracy of preoperative diagnosis of T staging of gastric cancer and provide more basis for the selection of preoperative treatment.

Key words: Gastric cancer, Neoplasm staging, Energy spectrum CT parameters

Wenpeng Huang, Liming Li, Zhiwei Hu, Chenchen Liu, Jingjing Xing, Jianbo Gao. Value of energy spectrum CT parameters in preoperative differentiation of stage T3 and T4a gastric cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(06): 257-262.

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Figures/Tables 7

References 15

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指标		T3期（n=23）	T4a期（n=29）	统计值	P值
年龄（±s，岁）		58.5±10.0	62.0±8.6	t=-1.349	0.183
性别（男性/女性，例）		19/4	20/9	χ²=1.273	0.259
肿瘤最厚径[M（Q_R），mm]		17.3（15.1，20.6）	17.3（13.9，19.3）	z=-0.368	0.713
Borrmann分型（例）				χ²=4.293	0.038
	Ⅰ型+Ⅱ型	11	6
	Ⅲ型+Ⅳ型	12	23
部位（例）				χ²=4.677	0.197
	贲门胃底	10	7
	胃体胃角	2	7
	胃窦幽门	7	6
	两个部位及以上	4	9
分化程度（例）				χ²=3.895	0.048
	低分化	5	14
	中高分化	18	15
CA125（例）				χ²=1.769	0.184
	正常	23	25
	升高	0	4
CA199（例）				χ²=0.001	1.000
	正常	19	24
	升高	4	5
CA153（例）^a				χ²=0	1.000
	正常	12	13
	升高	1	1
CA724（例）^b				χ²=0.062	0.804
	正常	17	18
	升高	2	4
CEA（例）^c				χ²=1.906	0.167
	正常	14	22
	升高	9	6

指标		T3期（n=23）	T4a期（n=29）	统计值	P值
年龄（±s，岁）		58.5±10.0	62.0±8.6	t=-1.349	0.183
性别（男性/女性，例）		19/4	20/9	χ²=1.273	0.259
肿瘤最厚径[M（Q_R），mm]		17.3（15.1，20.6）	17.3（13.9，19.3）	z=-0.368	0.713
Borrmann分型（例）				χ²=4.293	0.038
	Ⅰ型+Ⅱ型	11	6
	Ⅲ型+Ⅳ型	12	23
部位（例）				χ²=4.677	0.197
	贲门胃底	10	7
	胃体胃角	2	7
	胃窦幽门	7	6
	两个部位及以上	4	9
分化程度（例）				χ²=3.895	0.048
	低分化	5	14
	中高分化	18	15
CA125（例）				χ²=1.769	0.184
	正常	23	25
	升高	0	4
CA199（例）				χ²=0.001	1.000
	正常	19	24
	升高	4	5
CA153（例）^a				χ²=0	1.000
	正常	12	13
	升高	1	1
CA724（例）^b				χ²=0.062	0.804
	正常	17	18
	升高	2	4
CEA（例）^c				χ²=1.906	0.167
	正常	14	22
	升高	9	6

能谱CT参数		医师1	医师2	ICC	95%CI
胃癌原发灶
	动脉期IC值（±s，×100 μg/ml）	12.0±5.2	13.5±4.7	0.790	0.634-0.879
	静脉期IC值[M（Q_R），×100 μg/ml]	20.5（16.8，29.1）	22.5（19.1，26.6）	0.802	0.654-0.886
	动脉期nIC值（±s）	0.2±0.5	0.1±0.6	0.776	0.610-0.870
	静脉期nIC值[M（Q_R）]	0.5（0.4，0.6）	0.5（0.4，0.6）	0.836	0.715-0.906
胃癌周围脂肪间隙
	动脉期IC值[M（Q_R），×100 μg/ml]	-8.0（-12.6，-4.2）	-9.4（-12.0，-6.3）	0.695	0.468-0.825
	静脉期IC值（±s，×100 μg/ml）	-4.5±7.1	-4.2±6.8	0.606	0.314-0.774
	动脉期nIC值[M（Q_R）]	-0.1（-0.1，0.0）	0.1（-0.1，-0.1）	0.828	0.700-0.901
	静脉期nIC值（±s）	-0.1±0.2	-0.1±0.2	0.636	0.366-0.791

能谱CT参数		医师1	医师2	ICC	95%CI
胃癌原发灶
	动脉期IC值（±s，×100 μg/ml）	12.0±5.2	13.5±4.7	0.790	0.634-0.879
	静脉期IC值[M（Q_R），×100 μg/ml]	20.5（16.8，29.1）	22.5（19.1，26.6）	0.802	0.654-0.886
	动脉期nIC值（±s）	0.2±0.5	0.1±0.6	0.776	0.610-0.870
	静脉期nIC值[M（Q_R）]	0.5（0.4，0.6）	0.5（0.4，0.6）	0.836	0.715-0.906
胃癌周围脂肪间隙
	动脉期IC值[M（Q_R），×100 μg/ml]	-8.0（-12.6，-4.2）	-9.4（-12.0，-6.3）	0.695	0.468-0.825
	静脉期IC值（±s，×100 μg/ml）	-4.5±7.1	-4.2±6.8	0.606	0.314-0.774
	动脉期nIC值[M（Q_R）]	-0.1（-0.1，0.0）	0.1（-0.1，-0.1）	0.828	0.700-0.901
	静脉期nIC值（±s）	-0.1±0.2	-0.1±0.2	0.636	0.366-0.791

能谱CT参数		T3期（n=23）	T4a期（n=29）	统计值	P值
胃癌原发灶
	动脉期IC值（±s，×100 μg/ml）	12.5±5.8	11.6±4.7	t=0.576	0.567
	静脉期IC值[M（Q_R），×100 μg/ml]	19.3（16.9，21.9）	21.8（16.2，26.9）	z=-1.216	0.224
	动脉期nIC值（±s）	0.1±0.1	0.1±0.5	t=-0.068	0.946
	静脉期nIC值[M（Q_R）]	0.4（0.3，0.5）	0.5（0.4，0.6）	z=-1.704	0.088
胃癌周围脂肪间隙
	动脉期IC值[M（Q_R），×100 μg/ml]	-12.9（-14.2，-11.6）	-0.1（-0.2，-0.1）	z=-4.763	0.001
	静脉期IC值（±s，×100 μg/ml）	-9.2±6.1	-0.8±5.5	t=-0.630	0.001
	动脉期nIC值[M（Q_R）]	-0.1（-0.2，-0.1）	-0.1（-0.1，-0.0）	z=-4.339	0.001
	静脉期nIC值（±s）	-0.2±0.1	-0.0±0.1	t=-1.287	0.001

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