Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China.
BMC Med Imaging. 2024 Jan 19;24(1):20. doi: 10.1186/s12880-024-01200-z.
To explore the diagnostic value of multidetector computed tomography (MDCT) extramural vascular invasion (EMVI) in preoperative N Staging of gastric cancer patients.
According to the MR-defined EMVI scoring standard of rectal cancer, we developed a 5-point scale scoring system to evaluate the status of CT-detected extramural vascular invasion(ctEMVI), 0-2 points were ctEMVI-negative status, and 3-4 points were positive status for ctEMVI. Patients were divided into ctEMVI positive group and ctEMVI negative group. The correlation between ctEMVI and clinical features was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ctEMVI for pathological metastatic lymph nodes and N staging, The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of pathological N staging using ctEMVI and short-axis diameter were generated and compared.
The occurrence rate of lymphovascular invasion (LVI) and proportion of tumors with a greatest diameter > 6 cm in the ctEMVI positive group was higher than that in the ctEMVI negative group (P < 0.05). Spearman correlation analysis showed a positive correlation between ctEMVI and LVI, N stage, and tumor size (P < 0.05). For ctEMVI scores ≥ 3,The AUC of ctEMVI for diagnosing lymph node metastasis, N stage ≥ N2, and N3 stage were 0.857, 0.802, and 0.758, respectively. The sensitivity, NPV and accuracy of ctEMVI for diagnosing N stage ≥ N2 were superior to those of short-axis diameter (P < 0.05), while sensitivity, specificity, PPV, NPV, and accuracy of ctEMVI for diagnosing N3 stage were superior to those of short-axis diameter (P < 0.05).
ctEMVI has important value in diagnosing metastatic lymph nodes and advanced N staging. As an important imaging marker, ctEMVI can be included in the preoperative imaging evaluation of patients, providing important assistance for clinical guidance and treatment.
探讨多层螺旋 CT（MDCT）血管外侵犯（EMVI）在术前胃癌 N 分期中的诊断价值。
根据直肠癌 MRI 定义的 EMVI 评分标准，我们开发了一种 5 分制评分系统，用于评估 CT 检测到的血管外侵犯（ctEMVI）的状态，0-2 分为 ctEMVI 阴性状态，3-4 分为 ctEMVI 阳性状态。患者分为 ctEMVI 阳性组和 ctEMVI 阴性组。分析 ctEMVI 与临床特征的相关性。使用受试者工作特征（ROC）曲线评估 ctEMVI 对病理转移淋巴结和 N 分期的诊断效能，生成并比较 ctEMVI 和短轴直径用于病理 N 分期的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。
ctEMVI 阳性组的脉管侵犯（LVI）发生率和肿瘤最大直径>6cm 的比例均高于 ctEMVI 阴性组（P<0.05）。Spearman 相关分析显示，ctEMVI 与 LVI、N 分期和肿瘤大小呈正相关（P<0.05）。对于 ctEMVI 评分≥3，ctEMVI 诊断淋巴结转移、N 分期≥N2 和 N3 分期的 AUC 分别为 0.857、0.802 和 0.758。ctEMVI 诊断 N 分期≥N2 的敏感性、NPV 和准确性优于短轴直径（P<0.05），而 ctEMVI 诊断 N3 分期的敏感性、特异性、PPV、NPV 和准确性均优于短轴直径（P<0.05）。
ctEMVI 对诊断转移性淋巴结和晚期 N 分期具有重要价值。作为一种重要的影像学标志物，ctEMVI 可纳入患者术前影像学评估，为临床指导和治疗提供重要帮助。
