| Part 1Application Value of MDCT Image Texture Analysis in Evaluating the TN Staging of Gastric Cancer Objective To explore the clinical value of MDCT image texture analysis in evaluating the preoperative TN staging of gastric cancer.Methods A retrospective medical record review was conducted in 174 pathologically-proven gastric cancer patients in Ningxia Medical University General Hospital from July2017 and August 2018,all patients underwent contrast-enhanced CT scan before surgery.With pathology as the gold standard,the patients were divided into pT1-2 and pT3-4 stages,pN0 and pN1-3 stages.The CT texture parameters of primary lesions were measured by CT Kinetics texture analysis software in arterial and portal venous phase,including mean value,skewness,kurtosis,entropy and correlation texture parameters.The texture parameters were compared between pT1-2 and pT3-4 stages,pN0 and pN1-3 stages using two independent-Sample t test or Mann-Whitney U test.For statistically significant texture parameters,the receiver operating characteristic(ROC)curves were further plotted to evaluate their diagnosis performance.Multivariate Logistic regression analysis was used to determine the texture parameters that could predict T and N stage of gastric cancer.Result 1.The mean value,kurtosis,entropy and correlation of pT3-4 group were higher than those of pT1-2 group,but the skewness was lower than that of pT1-2 group in arterialand portal venous phases.Kurtosis and entropy were statistically significant differences between pT1-2 group and pT3-4 group in the arterial phase and portal venous phase(P<0.05).Correlation was statistically significant in the portal venous phase(P<0.05),but no statistically significant difference in the arterial phase(P>0.05).The mean value and skewness were not statistically significant difference between two groups in arterial and portal venous phases(P>0.05).2.Logistic multivariate regression analysis showed that kurtosis and entropy parameters in the arterial phase were independent predictors of preoperative T stage of gastric cancer,and the combined diagnostic performance was 0.777,the best threshold was9.29,the sensitivity and specificity were 77.8% and 71.8% respectively.3.The skewness,kurtosis,entropy and correlation of pN1-3 group were higher than those of pN0 group in arterial and portal venous phases.The mean value of pN1-3 group was higher than that of pN0 group in arterial phase,but lower than that of pN0 group in portal venous phase.Entropy and correlation parameters were statistically significant difference in the arterial phase and portal venous phase(P<0.05),but there was no statistically significant difference in mean value,skewness and kurtosis between two groups in arterial phase and portal venous phase(P>0.05).4.Logistic multivariate regression analysis showed that the entropy parameters in arterial phase was an independent predictor of preoperative N stage of gastric cancer,and the area under the ROC curves(AUC)of entropy parameters was 0.751,the best threshold was9.47,the sensitivity and specificity were 69.4% and 74.4% respectively.Conclusion Texture analysis based on enhanced CT image can be helpful for predicting T stage and N stage of gastric cancer.Part 2Application Value of MDCT Image Texture Analysis in Evaluating the Grading of Gastric Adenocarcinoma Objective To explore the clinical value of MDCT image texture analysis in the evaluation of grading of gastric adenocarcinoma.Methods A retrospective medical record review was conducted in 174 pathologically-proven gastric cancer patients in Ningxia Medical University General Hospital from July2017 and August 2018,all patients underwent contrast-enhanced CT scan before surgery.According to the WHO classification of gastric adenocarcinoma,the patients were divided into poorly differentiated,moderately and well differentiated adenocarcinoma.The CT texture parameters of primary lesions were measured by CT Kinetics texture analysis software in arterial and portal venous phase.Applying histogram parameters and gray level co-occurrence matrix to record texture analysis parameters,including max intensity,min intensity,mean value,percentiles(5th,10 th,25th,50 th,75th,90 th,95th percentile),skewness,kurtosis,entropy and correlation texture parameters.Correlations between CT texture parameters and grading of gastric adenocarcinoma were analyzed by Spearman correlation analysis.The texture parameters were compared between poorly differentiated and moderately-well differentiated adenocarcinoma using Mann-Whitney U test.For statistically significant texture parameters,the receiver operating characteristic(ROC)curves were further plotted to evaluate their diagnosis performance.Result 1.The max intensity,90 th percentile and 95 th percentile texture parameters were negatively correlated with the grading of gastric adenocarcinoma in the arterial phase(P<0.05),meanwhile the max intensity,mean value and percentiles(5th,10 th,25th,50 th,75th,90 th,95th percentile)texture parameters were negatively correlated with the grading of gastric adenocarcinoma in the portal venous phase(P<0.05).2.In portal venous phase,the max intensity,mean value,percentiles(5th,10 th,25th,50 th,75th,90 th,95th percentile)texture parameters were statistically significant differences between poorly differentiated and moderately-well differentiated adenocarcinoma(P<0.05).Other texture parameters between two groups were not statistically significant difference.3.In the portal venous phase,the area under the ROC curves(AUC)of texture parameters(max intensity,mean value,5th,10 th,25th,50 th,75th,90 th,95th percentile)in identifying poorly differentiated and moderately-well differentiated adenocarcinoma were 0.591 to 0.678,the sensitivity was56.5% to 67.2%,and the specificity was 55.8% to 76.7%,respectively.Conclusion The MDCT image texture analysis has certain value in the diagnosis of grading of gastric adenocarcinoma,mainly in the identification of poorly differentiated and moderately-well differentiated gastric adenocarcinoma in the portal venous phase. |
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