CT 灌注成像在评估 T1 期胃癌患者胃周淋巴结转移中的应用研究。
An application study of CT perfusion imaging in assessing metastatic involvement of perigastric lymph nodes in patients with T1 gastric cancer.
机构信息
Department of Radiology, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Jiangsu Province, 214062, China.
Department of Intervention, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Jiangsu Province, 214062, China.
出版信息
Br J Radiol. 2020 Feb 1;93(1106):20190790. doi: 10.1259/bjr.20190790. Epub 2019 Dec 3.
OBJECTIVE
To assess metastatic involvement of perigastric lymph nodes (PLN) in patients with T1 gastric cancer by using CT perfusion imaging (CTPI).
METHODS
A total of 82 annotated PLN of 33 patients with T1 gastric cancer confirmed by endoscopic ultrasonography underwent CTPI and portal phase CT scan before operation. The scan data were post-processed to acquire perfusion maps and calculate perfusion parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short axis diameters and perfusion parameters of PLN. According to the post-operative pathology result, PLN were divided into two groups: metastatic and inflammatory LN. Perfusion parameters values and the size of PLN between two groups were respectively compared statistically by test, and a receiver operating characteristic curve analysis was used to determine the optimal diagnostic cut-off value with sensitivity, specificity and area under the curve.
RESULTS
Examined 82 PLN were metastatic in 45 (54.9%) and inflammatory in 37 (45.1%). The mean values of perfusion parameters and the short axis diameters in metastatic and inflammatory PLN, respectively, were BF of 97.48 81.21 ml/100 mg /min ( < 0.001), PS of 45.11 36.80 ml/100 mg /min ( < 0.001), and the size of 1.51 cm 1.29 cm ( = 0.059). The sensitivity of 84.4%, specificity of 67.6% and area under the curve of 0.826 for BF with cut-off value of 88.89 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of PLN ( < 0.001).
CONCLUSION
CT perfusion parameters values were different between metastatic and inflammatory PLN in T1 gastric cancer. BF value may be the most reliable diagnostic marker of metastatic PLNs, and it is helpful for clinicians to choose treatment modality or management plan in T1 gastric cancer patients.
ADVANCES IN KNOWLEDGE
CTPI gives information on vascularization of LN.BF value might be a more effective marker than PS or the size of LN for differentiating metastatic from inflammatory LN in patients with T1 gastric cancer.
目的
利用 CT 灌注成像（CTPI）评估 T1 期胃癌患者胃周淋巴结（PLN）的转移情况。
方法
对 33 例经内镜超声检查证实为 T1 期胃癌的 82 个有标注的 PLN 患者进行 CTPI 和门静脉期 CT 扫描。扫描数据经过后处理，获得灌注图并计算灌注参数，包括血流（BF）和通透性表面积（PS）。一位放射科医生测量了 PLN 的短轴直径和灌注参数。根据术后病理结果，将 PLN 分为转移性和炎症性 PLN 两组。分别对两组的灌注参数值和 PLN 大小进行检验比较，并用受试者工作特征曲线分析确定具有敏感性、特异性和曲线下面积的最佳诊断截断值。
结果
检查的 82 个 PLN 中，45 个（54.9%）为转移性，37 个（45.1%）为炎症性。转移性和炎症性 PLN 的灌注参数和短轴直径的平均值分别为 BF 97.48 81.21 ml/100 mg/min（<0.001），PS 45.11 36.80 ml/100 mg/min（<0.001），大小为 1.51 cm 1.29 cm（=0.059）。BF 值为 88.89 ml/100 mg/min 时，对区分转移性和炎症性淋巴结的敏感度为 84.4%，特异性为 67.6%，曲线下面积为 0.826，均高于 PS 或 PLN 大小（<0.001）。
结论
T1 期胃癌中，转移性和炎症性 PLN 的 CT 灌注参数值不同。BF 值可能是转移性 PLN 最可靠的诊断标志物，有助于临床医生为 T1 期胃癌患者选择治疗方式或管理方案。
知识进展
CTPI 提供了关于 LN 血管化的信息。BF 值可能是一种比 PS 或 PLN 大小更有效的标志物，可用于区分 T1 期胃癌患者的转移性和炎症性 LN。
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