分析常规对比增强 MDCT 检查中食管壁的增强后衰减可以提高食管鳞癌新辅助放化疗后疗效评估中与食管壁厚度相比的诊断准确性。
Analyzing the post-contrast attenuation of the esophageal wall on routine contrast-enhanced MDCT examination can improve the diagnostic accuracy in response evaluation of the squamous cell esophageal carcinoma to neoadjuvant chemoradiotherapy in comparison with the esophageal wall thickness.
机构信息
Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, 11000, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
出版信息
Abdom Radiol (NY). 2019 May;44(5):1722-1733. doi: 10.1007/s00261-019-01911-w.
PURPOSE
To evaluate the accuracy of the multidetector computed tomography (MDCT) in the response evaluation of the esophageal squamous cell carcinoma (ESCC) to neoadjuvant chemoradiotherapy (nCRT) by analyzing the thickness and post-contrast attenuation of the esophageal wall after the nCRT.
METHODS
Contrast-enhanced (CE)-MDCT examinations in portal venous phase of one hundred patients with locally advanced ESCC who received nCRT and underwent esophageal resection and histopathology assessment of tumor regression grade (TRG) were retrospectively analyzed by measuring the maximal thickness and mean density of the esophageal wall in the segment involved by tumor and visually searching for hyperdense foci within it. Diagnostic performance was evaluated using the ROC analysis.
RESULTS
Average attenuation of the esophageal wall had stronger diagnostic performance for predicting pathologic complete regression (pCR) (AUC = 0.994; p < 0.001) in relation to maximal esophageal wall thickness (AUC = 0.731; p < 0.001). Maximal esophageal wall thickness ≤ 9 mm and average attenuation of the esophageal wall ≤ 64 HU predicted pCR with the sensitivity, specificity, and overall accuracy of 62.5%, 77.9%, and 73%, and 96.9%, 98.5%, and 98%, respectively. Combination of both cutoff values enabled correct assessment of pCR with the 100% accuracy. Visual detection of the hyperdense focus within the esophageal wall predicted pCR with the sensitivity, specificity, and overall accuracy values of 100%, 94.1%, and 96%, respectively.
CONCLUSION
Visual analysis and measurement of post-contrast attenuation of the esophageal wall after the nCRT can improve diagnostic accuracy of MDCT in the response evaluation of the ESCC to nCRT in comparison with measuring the esophageal wall thickness.
目的
通过分析新辅助放化疗（nCRT）后食管壁的厚度和增强衰减，评估多排螺旋 CT（MDCT）在评价食管鳞癌（ESCC）对 nCRT 反应中的准确性。
方法
回顾性分析 100 例接受 nCRT 并接受食管切除术和肿瘤消退分级（TRG）组织病理学评估的局部晚期 ESCC 患者的增强 MDCT 门静脉期检查，测量肿瘤累及段食管壁的最大厚度和平均密度，并在其中视觉搜索高密度灶。使用 ROC 分析评估诊断性能。
结果
食管壁平均衰减在预测病理完全缓解（pCR）方面具有更好的诊断性能（AUC=0.994；p<0.001），优于最大食管壁厚度（AUC=0.731；p<0.001）。最大食管壁厚度≤9mm 和食管壁平均衰减≤64HU 预测 pCR 的敏感性、特异性和总准确性分别为 62.5%、77.9%和 73%，96.9%、98.5%和 98%。两种截断值的组合可实现 pCR 的准确评估，准确率为 100%。食管壁内高密度灶的视觉检测预测 pCR 的敏感性、特异性和总准确性分别为 100%、94.1%和 96%。
结论
与测量食管壁厚度相比，nCRT 后食管壁增强衰减的视觉分析和测量可提高 MDCT 在评价 ESCC 对 nCRT 反应中的诊断准确性。
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