Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China.
Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China.
Diagn Interv Imaging. 2022 Dec;103(12):584-593. doi: 10.1016/j.diii.2022.07.004. Epub 2022 Aug 5.
The purpose of this study was to investigate the utility of combining clinical and spectral computed tomography (CT) parameters for the preoperative evaluation of lymphovascular invasion (LVI) and perineural invasion (PNI) in gastric cancers (GCs).
Patients with gastric adenocarcinoma who underwent spectral-CT examination were retrospectively examined. All diagnoses were confirmed by pathology, and the patients were divided into positive and negative groups based on LVI/PNI occurrence. Clinical characteristics, including demographic information, serum tumor markers, and gastroscopic pathological information, were collected. The effective atomic number (Z), iodine concentration (IC), and water concentration were measured in the arterial (AP) and venous phase (VP). Differences between the two groups were searched for using independent sample t-test, Mann-Whitney U test, or chi-square (χ) test and diagnostic performances of the different variables were evaluated using receiver operating characteristic (ROC) curve.
A total of 121 patients (96 men, 25 women; mean age: 59 ± 8.7 [SD] years, range: 36-82 years) with gastric adenocarcinoma were included in the study. The serum level of the tumor marker CA125, as well as Z and IC in the LVI/PNI-positive group, were significantly higher than in the negative group, and the histological grade and Borrmann type differed between the two groups (all P < 0.05). The discriminating capability analysis demonstrated that CA125 exhibited a favorable performance, and the VP parameters' diagnostic efficacy was superior to that of the AP parameters. The efficacy of the combination of clinical and spectral-CT parameters was superior to that of individual parameters (all AUC > 0.85). The clinical parameters combined with Z and IC in the AP and VP exhibited a high evaluation efficacy (AUC = 0.890 [95% CI: 0.826-0.955]; F score = 0.888; accuracy = 84.3% [102/121; 95% CI: 76.7-89.8]; sensitivity = 86.2% [75/87; 95% CI: 76.8-92.4]; specificity = 79.4% [27/34; 95% CI: 61.6-90.1]).
Clinical and spectral-CT parameters exhibit considerable capabilities in the preoperative evaluation of LVI and PNI in GCs. The combination of clinical and spectral-CT parameters effectively predicts LVI and PNI in GCs.
本研究旨在探讨联合临床和光谱 CT 参数在术前评估胃癌（GCs）中淋巴管浸润（LVI）和神经周围浸润（PNI）的效用。
回顾性分析了接受光谱 CT 检查的胃腺癌患者。所有诊断均经病理证实，并根据 LVI/PNI 发生情况将患者分为阳性组和阴性组。收集临床特征，包括人口统计学信息、血清肿瘤标志物和胃镜病理信息。在动脉期（AP）和静脉期（VP）测量有效原子数（Z）、碘浓度（IC）和水浓度。采用独立样本 t 检验、Mann-Whitney U 检验或卡方（χ）检验比较两组间差异，采用受试者工作特征（ROC）曲线评价不同变量的诊断性能。
共纳入 121 例胃腺癌患者（96 例男性，25 例女性；平均年龄 59±8.7[标准差]岁，范围 36-82 岁）。LVI/PNI 阳性组的肿瘤标志物 CA125 血清水平以及 Z 和 IC 值均显著高于阴性组，两组的组织学分级和 Borrmann 分型不同（均 P<0.05）。鉴别能力分析表明，CA125 表现出良好的性能，VP 参数的诊断效能优于 AP 参数。临床和光谱 CT 参数的联合优于单一参数（AUC>0.85）。AP 和 VP 中的临床参数与 Z 和 IC 联合具有较高的评估效能（AUC=0.890[95%CI：0.826-0.955]；F 评分=0.888；准确性=84.3%[121/121；95%CI：76.7-89.8]；灵敏度=86.2%[75/87；95%CI：76.8-92.4]；特异性=79.4%[27/34；95%CI：61.6-90.1]）。
临床和光谱 CT 参数在术前评估 GCs 的 LVI 和 PNI 方面具有相当的能力。临床和光谱 CT 参数的联合可有效预测 GCs 的 LVI 和 PNI。
