Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing City, 210008, Jiangsu Province, China.
Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing City, 210008, Jiangsu Province, China.
Eur Radiol. 2021 Aug;31(8):5768-5778. doi: 10.1007/s00330-021-07697-0. Epub 2021 Feb 10.
To summarise the CT findings of gastric poorly cohesive carcinoma (PCC) in the 40 s late arterial phase and differentiate it from tubular adenocarcinoma (TAC) using an integrative nomogram.
A total of 241 patients including 59 PCCs, 109 TACs, and 73 other type gastric cancers were enrolled. Thirteen CT morphological characteristics of each lesion in the late arterial phase were evaluated. In addition, CT value-related parameters were extracted from ROIs encompassing the area of greatest enhancement on four-phase CT images. Nomograms based on regression models were built to discriminate PCCs from TACs and from non-PCCs. ROC curve analysis was performed to assess the diagnostic efficiency.
Six morphological characteristics, 10 CT value-related parameters, and the enhanced curve types differed significantly among the above three groups in the primary cohort (all p < 0.05). The paired comparison revealed that 10 CT value-related parameters differed significantly between PCCs and TACs (all p < 0.05). The AUC of the nomogram based on the multivariate model for discriminating PCCs from TACs was 0.954, which was confirmed in the validation cohort (AUC = 0.895). The AUC of another nomogram for discriminating PCCs from non-PCCs was 0.938, which was confirmed in the validation cohort (AUC = 0.880).
In the 40 s late arterial phase, the morphological characteristics and CT value-related parameters were significantly different among PCCs, TACs, and other types. PCCs were prone to manifest mucosal line interruption, diffuse thickening, infiltrative growth, and slow-rising enhanced curve (Type A). Furthermore, multivariate models were useful in discriminating PCCs from TACs and other types.
• Multiple morphological characteristics and CT value-related parameters differed significantly between gastric PCCs and TACs in the 40 s late arterial phase. • The nomogram integrating morphological characteristics and CT value-related parameters in the 40 s late arterial phase had favourable performance in discriminating PCCs from TACs. • More useful information can be derived from 40 s late arterial phase CT images; thus, a more accurate evaluation can be made in clinical practice.
总结胃低黏附性腺癌（PCC）在 40 多岁晚期动脉期的 CT 表现，并利用综合列线图将其与管状腺癌（TAC）区分开来。
共纳入 241 例患者，包括 59 例 PCC、109 例 TAC 和 73 例其他类型胃癌。评估每个病变在晚期动脉期的 13 个 CT 形态特征。此外，还从四期 CT 图像上最大增强区域提取 CT 值相关参数。基于回归模型建立列线图，以区分 PCC 和 TAC 以及非 PCC。通过 ROC 曲线分析评估诊断效率。
在主要队列中，三组之间有 6 个形态特征、10 个 CT 值相关参数和增强曲线类型存在显著差异（均 p < 0.05）。配对比较显示，PCC 和 TAC 之间的 10 个 CT 值相关参数存在显著差异（均 p < 0.05）。基于多变量模型用于区分 PCC 和 TAC 的列线图的 AUC 在验证队列中得到验证（AUC = 0.895）为 0.954。用于区分 PCC 和非 PCC 的另一个列线图的 AUC 在验证队列中得到验证（AUC = 0.880）为 0.938。
在 40 多岁晚期动脉期，PCC、TAC 和其他类型之间的形态特征和 CT 值相关参数存在显著差异。PCC 更倾向于表现为黏膜线中断、弥漫性增厚、浸润性生长和缓慢上升的增强曲线（A型）。此外，多变量模型有助于区分 PCC 和 TAC。
胃 PCC 和 TAC 在 40 多岁晚期动脉期之间存在多个形态特征和 CT 值相关参数的显著差异。
综合 40 多岁晚期动脉期形态特征和 CT 值相关参数的列线图在区分 PCC 和 TAC 方面具有良好的性能。
40 多岁晚期动脉期 CT 图像可提供更多有用信息，从而在临床实践中进行更准确的评估。
