Pan Xuelin, Wu Zhihan, Zhao Jin, Zhang Xinyi, Zhang Xiaodi, Tang Li, Yang Jinlin, Deng Kai
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8260-8271. doi: 10.21037/qims-24-769. Epub 2024 Oct 28.
Early rectal neoplasms can be treated endoscopically with good prognosis, yet usually present with unspecific or an absence of signs and symptoms and are detected largely by invasive endoscopy with less compliance to screening. The purpose of this cross-sectional study was to explore the diagnostic value of dual-layer spectral detector computed tomography (DSCT) imaging for early rectal neoplasm.
Patients who underwent DSCT for evaluation of rectal lesion or routine examination between September 2022 to September 2023 at West China Hospital were prospectively included and identified as group A (control, n=76), group B (rectal advanced adenomas and ≤T1 rectal cancer, n=59), and group C (≥T2 staging rectal cancer, n=74). Lesion visualization was graded to assess image quality. Spectral quantitative measurement, such as Hounsfield unit (HU), HU, iodine concentration (IC), effective atomic number (Zeff), and the slope of spectral curve (λ), was analyzed and compared. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic efficacy of spectral parameters. A comparison of ROC curves was applied to test the significance of differences between the area under the curves (AUCs).
Compared to poly-energetic images (PEIs), the multiple parameters from DSCT were of greater capability to recognize rectal lesions. There were significant differences in HU (208.01±43.60 . 255.53±45.16), HU (87.06±18.55 . 100.78±18.26), IC [1.91 (1.71, 2.28) . 2.58±0.49], Zeff [8.33 (8.25, 8.50) . 8.61±0.20], and λ [3.80 (3.41, 4.52) . 5.16±1.00] between the early neoplastic lesions in rectum and the advanced rectal cancer (P<0.001). Significant correlations were found between the DSCT parameters and tumor staging (P<0.001). Furthermore, the AUCs of IC, Zeff, λ, and HU were all above 0.90 for early rectal neoplasm detection, with additional capability of discriminating early rectal neoplasm from advanced rectal cancer.
DSCT improved tumor conspicuity and the detection of the early rectal neoplastic lesion, suggesting that it is a promising screening tool in clinical practice.
早期直肠肿瘤可通过内镜治疗，预后良好，但通常表现为非特异性症状或无症状，主要通过侵入性内镜检查发现，筛查依从性较低。本横断面研究的目的是探讨双层光谱探测器计算机断层扫描（DSCT）成像对早期直肠肿瘤的诊断价值。
前瞻性纳入2022年9月至2023年9月在华西医院因直肠病变评估或常规检查而接受DSCT检查的患者，并将其分为A组（对照组，n = 76）、B组（直肠高级别腺瘤和T1期直肠癌，n = 59）和C组（T2期及以上直肠癌，n = 74）。对病变可视化进行分级以评估图像质量。分析并比较了光谱定量测量值，如亨氏单位（HU）、碘浓度（IC）、有效原子序数（Zeff）和光谱曲线斜率（λ）。绘制受试者工作特征（ROC）曲线以评估光谱参数的诊断效能。应用ROC曲线比较检验曲线下面积（AUC）之间差异的显著性。
与多能量图像（PEI）相比，DSCT的多个参数识别直肠病变的能力更强。直肠早期肿瘤性病变与晚期直肠癌之间的HU（208.01±43.60对255.53±45.16）、HU（87.06±18.55对100.78±18.26）、IC[1.91（1.71，2.28）对2.58±0.49]、Zeff[8.33（8.25，8.50）对8.61±0.20]和λ[3.80（3.41，4.52）对5.16±1.00]存在显著差异（P<0.001）。DSCT参数与肿瘤分期之间存在显著相关性（P<0.001）。此外，IC、Zeff、λ和HU的AUC在早期直肠肿瘤检测中均高于0.90，且具有区分早期直肠肿瘤与晚期直肠癌的额外能力。
DSCT提高了肿瘤的显影性及早期直肠肿瘤性病变的检出率，表明它是临床实践中有前景的筛查工具。
