Department of Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210009, Jiangsu Province, China.
Abdom Radiol (NY). 2024 Oct;49(10):3309-3318. doi: 10.1007/s00261-024-04303-x. Epub 2024 Apr 18.
To explore whether dual-energy CT (DECT) quantitative parameters could provide analytic value for the diagnosis of patients with occult peritoneal metastasis (OPM) in advanced gastric cancer preoperatively.
This retrospective study included 219 patients with advanced gastric cancer and DECT scans. The patient's clinical data and DECT related iodine concentration (IC) parameters and effective atomic number (Z) were collated and analyzed among noun-peritoneal metastasis (NPM), OPM and radiologically peritoneal metastasis (RPM) groups. The predictive performance of the DECT parameters was compared with that of the conventional CT features and clinical characteristics through evaluating area under curve of the precision-recall (AUC-PR), F1 score, balanced accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
Borrmann IV type diagnosed on CT and serum tumor indicator CA125 index were statistically different between the NPM and OPM groups. DECT parameters included IC, normalized IC (NIC), and Z of PM group were lower than the NPM group. The DECT predictive nomogram combined three independent DECT parameters produced a better diagnostic performance than the conventional CT feature Borrmann IV type and serum CA125 index in AUC-PR with 0.884 vs 0.368 vs 0.189, but similar to the combined indicator which was based on the DECT parameters, the conventional CT feature, and serum CA125 index in AUC-PR with 0.884 vs 0.918.
The lower quantitative NIC, IC ratio, and Z on DECT was associated with peritoneal metastasis in advanced gastric cancer and was promising to identify patients with OPM noninvasively.
探讨双能 CT（DECT）定量参数是否能为术前诊断晚期胃癌隐匿性腹膜转移（OPM）患者提供分析价值。
本回顾性研究纳入 219 例晚期胃癌患者和 DECT 扫描患者。对无腹膜转移（NPM）、OPM 和影像学腹膜转移（RPM）组患者的临床资料和 DECT 相关碘浓度（IC）参数及有效原子序数（Z）进行整理和分析。通过评估精确召回曲线下面积（AUC-PR）、F1 评分、平衡准确率、敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV），比较 DECT 参数与常规 CT 特征和临床特征的预测性能。
CT 诊断的 Borrmann IV 型和血清肿瘤标志物 CA125 指数在 NPM 和 OPM 组之间存在统计学差异。PM 组的 DECT 参数包括 IC、NIC 和 Z 均低于 NPM 组。与常规 CT 特征 Borrmann IV 型和血清 CA125 指数相比，基于三个独立 DECT 参数的 DECT 预测列线图在 AUC-PR 中具有更好的诊断性能，分别为 0.884、0.368 和 0.189，但与基于 DECT 参数、常规 CT 特征和血清 CA125 指数的联合指标在 AUC-PR 中的 0.884 相似。
DECT 上较低的定量 NIC、IC 比值和 Z 与晚期胃癌腹膜转移相关，有望无创识别 OPM 患者。
