North China University Of Science And Technology Affiliated Hospital, Tangshan, Hebei, 063000, China.
BMC Med Imaging. 2024 May 21;24(1):116. doi: 10.1186/s12880-024-01291-8.
Evaluation of the predictive value of one-stop energy spectrum and perfusion CT parameters for microvessel density (MVD) in colorectal cancer cancer foci.
Clinical and CT data of 82 patients with colorectal cancer confirmed by preoperative colonoscopy or surgical pathology in our hospital from September 2019 to November 2022 were collected and analyzed retrospectively. Energy spectrum CT images were measured using the Protocols general module of the GSI Viewer software of the GE AW 4.7 post-processing workstation to measure the CT values of the arterial and venous phase lesions and the neighboring normal intestinal wall in a single energy range of 40 kev∼140 kev, and the slopes of the energy spectrum curves (λ) were calculated between 40 kev-90 kev; Iodine concentration (IC), Water concentration (WC), Effective-Z (Eff-Z) and Normalized iodine concentration (NIC) were measured by placing a region of interest (ROI) on the iodine concentration map and water concentration map at the lesion and adjacent to the normal intestinal wall.Perfusion CT images were scanned continuously and dynamically using GSI Perfusion software and analyzed by applying CT Perfusion 4.0 software.Blood volume (BV), blood flow (BF), surface permeability (PS), time to peak (TTP), and mean transit time (MTT) were measured respectively in the lesion and adjacent normal colorectal wall. Based on the pathological findings, the tumors were divided into a low MVD group (MVD < 35/field of view, n = 52 cases) and a high MVD group (MVD ≥ 35/field of view, n = 30 cases) using a median of 35/field of view as the MVD grouping criterion. The collected data were statistically analyzed, the subjects' operating characteristic curve (ROC) was plotted, and the area under curve (AUC), sensitivity, specificity, and Yoden index were calculated for the predicted efficacy of each parameter of the energy spectrum and perfusion CT and the combined parameters.
The CT values, IC, NIC, λ, Eff-Z of 40kev∼140kev single energy in the arterial and venous phase of colorectal cancer in the high MVD group were higher than those in the low MVD group, and the differences were all statistically significant (p < 0.05). The AUC of each single-energy CT value in the arterial phase from 40 kev to 120 kev for determining the high or low MVD of colorectal cancer was greater than 0.8, indicating that arterial stage has a good predictive value for high or low MVD in colorectal cancer; AUC for arterial IC, NIC and IC + NIC were all greater than 0.9, indicating that in arterial colorectal cancer, both single and combined parameters of spectral CT are highly effective in predicting the level of MVD. The AUC of 40 kev to 90 kev single-energy CT values in the intravenous phase was greater than 0.9, and its diagnostic efficacy was more representative; The AUC of IC and NIC in venous stage were greater than 0.8, which indicating that the IC and NIC energy spectrum parameters in venous stage colorectal cancer have a very good predictive value for the difference between high and low MVDs, with the greatest diagnostic efficacy in IC.The values of BV and BF in the high MVD group were higher than those in the low MVD group, and the differences were statistically significant (P < 0.05), and the AUC of BF, BV, and BV + BF were 0.991, 0.733, and 0.997, respectively, with the highest diagnostic efficacy for determining the level of MVD in colorectal cancer by BV + BF.
One-stop CT energy spectrum and perfusion imaging technology can accurately reflect the MVD in living tumor tissues, which in turn reflects the tumor angiogenesis, and to a certain extent helps to determine the malignancy, invasion and metastasis of living colorectal cancer tumor tissues based on CT energy spectrum and perfusion parameters.
评估一站式能谱和灌注 CT 参数对结直肠癌病灶微血管密度（MVD）的预测价值。
回顾性分析 2019 年 9 月至 2022 年 11 月我院经术前结肠镜或手术病理证实的 82 例结直肠癌患者的临床和 CT 资料。使用 GE AW 4.7 后处理工作站的 GSI Viewer 软件的常规模块测量能谱 CT 图像，以测量单能范围 40 kev∼140 kev 内动脉期和静脉期病变及邻近正常肠壁的 CT 值，并计算 40 kev-90 kev 之间的能谱曲线斜率（λ）；通过在碘浓度图和水浓度图上放置病变和邻近正常肠壁的感兴趣区（ROI）来测量碘浓度（IC）、水浓度（WC）、有效 Z 值（Eff-Z）和归一化碘浓度（NIC）。使用 GSI 灌注软件连续动态扫描灌注 CT 图像，并使用 CT 灌注 4.0 软件进行分析。分别在病变和邻近正常结直肠壁测量血容量（BV）、血流（BF）、表面通透性（PS）、达峰时间（TTP）和平均通过时间（MTT）。根据病理结果，以中位数 35/视野为 MVD 分组标准，将肿瘤分为低 MVD 组（MVD<35/视野，n=52 例）和高 MVD 组（MVD≥35/视野，n=30 例）。对收集的数据进行统计学分析，绘制受试者工作特征曲线（ROC），计算能谱和灌注 CT 各参数及联合参数对预测结直肠癌 MVD 效能的曲线下面积（AUC）、敏感度、特异度和 Yoden 指数。
高 MVD 组结直肠癌动、静脉期的单能 CT 值（40kev∼140kev）、IC、NIC、λ、Eff-Z 均高于低 MVD 组，差异均有统计学意义（p<0.05）。动脉期 40 kev 至 120 kev 各单能 CT 值预测结直肠癌高、低 MVD 的 AUC 均大于 0.8，表明动脉期对结直肠癌高、低 MVD 有较好的预测价值；动脉期 IC、NIC 和 IC+NIC 的 AUC 均大于 0.9，表明在动脉期结直肠癌中，光谱 CT 的单参数和联合参数均能高度有效地预测 MVD 水平。静脉期 40 kev 至 90 kev 单能 CT 值的 AUC 大于 0.9，其诊断效能更具代表性；静脉期 IC 和 NIC 的 AUC 均大于 0.8，表明静脉期结直肠癌的 IC 和 NIC 能谱参数对高、低 MVD 差异具有很好的预测价值，其中 IC 的诊断效能最大。高 MVD 组的 BV 和 BF 值均高于低 MVD 组，差异有统计学意义（P<0.05），BF、BV 和 BV+BF 的 AUC 分别为 0.991、0.733 和 0.997，以 BV+BF 联合诊断结直肠癌 MVD 水平的诊断效能最高。
一站式 CT 能谱和灌注成像技术能准确反映活体肿瘤组织中的 MVD，进而反映肿瘤血管生成情况，在一定程度上有助于根据 CT 能谱和灌注参数判断活体结直肠癌肿瘤组织的恶性程度、侵袭和转移。
