Jee Han Bum, Park Min Jung, Lee Hye Sun, Park Mi-Suk, Kim Myeong-Jin, Chung Yong Eun
Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Ajou university school of medicine, Suwon, Republic of Korea.
PLoS One. 2015 Jul 28;10(7):e0134133. doi: 10.1371/journal.pone.0134133. eCollection 2015.
To evaluate the appropriateness of follow-up with only non-enhanced CT (NECT) in patients with gastrointestinal cancer.
This retrospective study included 323 patients with colorectal and gastric cancer who underwent two consecutive CT examinations (CT1 and CT2), including non-contrast and portal venous phase CT images, with an interval of 1 year. Patients were divided into 2 groups: Group A included patients with no hepatic metastasis on CT1 and with or without newly developed metastasis on CT2 to evaluate the diagnostic performance of NECT for detecting newly developed hepatic metastasis; Group B included patients with known hepatic metastasis both on CT1 and CT2 to evaluate the accuracy of NECT for the assessment of hepatic metastasis based on RECIST criteria (version 1.1). Contrast-enhanced CT (CECT) images were considered as reference standards.
Group A included 172 patients (M:F = 107:65; mean age, 62.6 years). Among them, 57 patients had 95 metastases (mean size, 2.2 ± 1.3 cm). Per patient and per lesion sensitivity for diagnosing newly developed hepatic metastasis was 56.1-66.7% and 52.6-56.8%, respectively. In terms of small metastases (<1.5 cm), per lesion sensitivity was significantly decreased to 28.1-34.4% (P < 0.05). Metastasis size measurements were significantly smaller on NECT (P < 0.001) compared with reference standards. In Group B, the accuracy of response evaluation based on RECIST criteria was 65.6-72.2%.
NECT showed inadequate diagnostic performances in both detecting newly developed hepatic metastasis and evaluating the response of hepatic metastasis based on RECIST criteria.
评估仅采用非增强CT（NECT）对胃肠道癌患者进行随访的适宜性。
这项回顾性研究纳入了323例结直肠癌和胃癌患者，这些患者连续接受了两次CT检查（CT1和CT2），包括平扫和门静脉期CT图像，间隔时间为1年。患者分为两组：A组包括CT1时无肝转移且CT2时有或无新出现转移的患者，以评估NECT检测新出现肝转移的诊断性能；B组包括CT1和CT2时均已知有肝转移的患者，以评估NECT根据RECIST标准（第1.1版）评估肝转移反应的准确性。增强CT（CECT）图像被视为参考标准。
A组包括172例患者（男∶女 = 107∶65；平均年龄62.6岁）。其中，57例患者有95处转移灶（平均大小2.2±1.3 cm）。诊断新出现肝转移的 per patient 和 per lesion 敏感性分别为56.1% - 66.7%和52.6% - 56.8%。对于小转移灶（<1.5 cm），per lesion 敏感性显著降至28.1% - 34.4%（P < 0.05）。与参考标准相比，NECT上转移灶大小测量值显著更小（P < 0.001）。在B组中，基于RECIST标准的反应评估准确性为65.6% - 72.2%。
NECT在检测新出现的肝转移以及根据RECIST标准评估肝转移反应方面均显示出诊断性能不足。
