Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia 010050, China.
Graduate School of the First Clinical Medical College, Inner Mongolia Medical University, Huhhot, Inner Mongolia 010050, China.
Eur J Radiol. 2023 Jan;158:110618. doi: 10.1016/j.ejrad.2022.110618. Epub 2022 Nov 23.
This study aimed to investigate whether histopathological confirmed extramural vascular invasion (EMVI) is associated with quantitative parameters derived from dual-energy computed tomography (DECT) of rectal cancer.
This retrospective study included patients with rectal cancer who underwent rectal cancer surgery and DECT (including arterial-, venous-, and delay-phase scanning) between November 2019 and November 2020. The EMVI of rectal cancer was confirmed via postoperative pathological results. Iodine concentration (IC), IC normalized to the aorta (NIC), and CT attenuation values of the three phases were measured and compared between patients with and without EMVI. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic performance of these DECT quantitative parameters.
Herein, 36 patients (22 men and 14 women) with a mean age of 62 [range, 43-77] years) with (n = 13) and without (n = 23) EMVI were included. Patients with EMVI exhibited significantly higher IC in the venous and delay phases (venous-phase: 2.92 ± 0.6 vs 2.34 ± 0.48; delay-phase: 2.46 ± 0.47 vs 1.88 ± 0.35) and NIC in all the three phases (arterial-phase: 0.31 ± 0.12 vs 0.24 ± 0.06; venous-phase: 0.58 ± 0.11 vs 0.41 ± 0.07; delay-phase: 0.68 ± 0.10 vs 0.46 ± 0.08) than patients without EMVI. Among them, the highest area under the ROC curve (AUC) was obtained in the delay-phase NIC (AUC = 0.983). IC in the arterial-phase and CT attenuation in all the three phases did not significantly differ between patients with and without EMVI (p = 0.205-0.869).
Iodine quantification using dual-energy CT, especially the NIC of the tumor, differs between the EMVI-positive and EMVI-negative groups and seems to help predict the EMVI of rectal cancer in this preliminary study; however, a larger sample size study is warranted in the future.
本研究旨在探讨经组织学证实的直肠癌外膜血管侵犯（EMVI）与直肠癌双能量 CT（DECT）定量参数之间的关系。
本回顾性研究纳入了 2019 年 11 月至 2020 年 11 月期间接受直肠癌手术和 DECT（包括动脉期、静脉期和延迟期扫描）的直肠癌患者。术后病理结果证实了直肠癌的 EMVI。测量并比较了 EMVI 阳性和阴性患者的碘浓度（IC）、IC 与主动脉标准化（NIC）和三期 CT 衰减值。绘制受试者工作特征（ROC）曲线，以确定这些 DECT 定量参数的诊断性能。
本研究共纳入 36 例患者（22 名男性，14 名女性；平均年龄 62 [范围，43-77] 岁），其中 13 例患者存在 EMVI（EMVI 阳性组），23 例患者不存在 EMVI（EMVI 阴性组）。EMVI 阳性组患者静脉期和延迟期的 IC 明显高于 EMVI 阴性组（静脉期：2.92±0.6 比 2.34±0.48；延迟期：2.46±0.47 比 1.88±0.35），动脉期、静脉期和延迟期的 NIC 也明显高于 EMVI 阴性组（动脉期：0.31±0.12 比 0.24±0.06；静脉期：0.58±0.11 比 0.41±0.07；延迟期：0.68±0.10 比 0.46±0.08）。其中，延迟期 NIC 的 ROC 曲线下面积（AUC）最大（AUC=0.983）。动脉期 IC 和三期 CT 衰减值在 EMVI 阳性组和 EMVI 阴性组之间无显著差异（p=0.205-0.869）。
本研究初步表明，使用双能 CT 进行碘定量，尤其是肿瘤 NIC，在 EMVI 阳性和 EMVI 阴性组之间存在差异，似乎有助于预测直肠癌的 EMVI；但未来需要更大的样本量研究。
