| Part I: The clinical value of spectral CT imaging in assessing gastric adenocarcinoma angiogenesis and prognosisObjective To explore the relationship among spectral CT quantitative parameter values and pathological indications, including p TNM staging, pathological staging, grade, degree of differentiation and lymph node metastasis, distant metastasis, MVD, and to provide objective imaging foundation for prognosis assessment of gastric adenocarcinoma.Material and methods Thirty-four patients with pathologically confirmed gastric adenocarcinoma in patients were prospectively collected in our hospital from June 2012 to December 2015. All enrolled patients underwent dual-phase enhanced spectral CT examination, iodine-based IC value on arterial phase(IC AP) and iodine-based IC on venous arterial phase(IC PP) value of gastric lesion within the scope of ROI could be generated automatically by GSI Viewer software; Simultaneously, IC value of the abdominal aorta on the same layer as a standard reference value, used ratio of tumors’ IC of each phase and IC of abdominal aorta as the standardized iodine base value(n IC) of tumors, arterial phase standardized iodine base value(n IC AP) and venous phase standardized iodine base value(n IC PP) can be obtained, respectively. To analyze the relationship among spectral CT quantitative parameters values with pathological indications, including p TNM staging, pathological staging, grade, degree of differentiation and lymph node metastasis, distant metastasis and MVD. Comparison between groups using independent sample t test, correlations among variables were analyzed through Pearson linear correlation or Spearman rank correlation analysis.Results 1. The arterial and venous phase IC and n IC value of poorly differentiated adenocarcinoma were higher than moderately differentiated adenocarcinoma. With the exception of IC AP(t=1.494, P>0.05), the differences of IC PP(t=2.100, P<0.05), n IC AP(t=2.984, P<0.05) and n IC PP(t=2.620, P<0.05) between the two groups were statistically significant. 2. Spectral CT quantitative parameter values of tumors with serosa violations and distant metastasis were slightly higher than tumors without serosa violations and distant metastasis, there was no statistically significant difference between the two groups(P>0.05). 3. Pearson correlation analysis showed that excluding IC PP, IC AP and n IC AP, n IC PP and the MVD was positively correlated(P<0.05). Spectral CT quantitative parameter values of gastric adenocarcinoma can reflect tumor angiogenesis state, to some extent. 4. Spectral CT quantitative parameter values of high MVD group were higher than the low MVD group, and IC AP, n IC PP of the two groups was statistically significantly differenct(P<0.05). 5. There were no significant correlation(P>0.05) between spectral CT values quantitative parameters values of gastric adenocarcinoma with lymph node metastasis and p TNM. The correlation between IC PP and n IC PP with different N classification was slightly better than n IC AP and IC AP. The correlations between IC AP and n IC PP with different p TNM staging was slightly better than IC PP and n IC AP.Conclusion 1. Spectral CT imaging of gastric adenocarcinoma can be non-invasive, rapid and accurate assessment of tumor hemodynamic information and can reveal tumor angiogenesis state. 2. IC PP, n IC AP and n IC PP can reflect the degree of differentiation of gastric adenocarcinoma. With the increase of MVD value and decreases of differentiated degree, the spectral CT parameter values of gastric adenocarcinoma gradually increase. 3. The value of spectral CT quantitative parameters in predicting serosa violations, lymph node metastasis, distant metastasis of gastric adenocarcinoma is limited, combined with the bulk of cases and further study was needed.Part II: Study of spectral CT quantitative parameters value to assess the degree of differentiation of gastric adenocarcinoma and its relationship with clinicopathological featuresObjective To explore relationship among spectral CT quantitative parameters of gastric adenocarcinoma with age, gender, location, tumor maximum diameter and provide objective imaging foundation for assessing the pathological features of gastric adenocarcinoma patients.Material and methods One hundred and fifty three inpatients with histologically confirmed gastric adenocarcinoma were examined by spectral dual-phase enhanced CT examination before surgery, iodine-based IC value(IC AP) and venous phase IC(IC PP) value of gastric lesion within the scope of ROI on arterial and venous arterial phase can be generated automatically by GSI Viewer software; Simultaneously, IC value of the abdominal aorta on the same layer as a standard reference value, used ratio of tumors’ IC of each phase and IC of abdominal aorta as the standardized iodine base value(n IC) of tumors, arterial phase standardized iodine base value(n IC AP) and venous phase standardized iodine base value(n IC PP) can be obtained respectively. To analyze the relationship among spectral CT quantitative parameters values with age, gender, location, maximum diameter. Comparison between groups using independent sample t test, correlations among variables were analyzed through Pearson linear correlation or Spearman rank correlation analysis. Comparison between groups using independent samples t-test or one-way ANOVA, using Pearson correlation analysis method to analyze the correction between spectral CT quantitative parameters of each site and tumor maximum diameter, using chi-square test to compare the difference in the differentiated degree of gastric adenocarcinoma on different site. Diagnostic value of spectral CT quantitative parameters in evaluating differentiated degree of gastric adenocarcinoma was analyzed by Receiver operating characteristic(ROC) analysis, the area under the curve as a criterion to assess its value, and choose the best diagnostic threshold, the sensitivity and computing specificity.Results 1.IC AP, IC PP and n IC AP value of male patients were lower than female patients, but the difference was not statistically significant(t values were 1.288,1.400 and 1.748, p>0.05); Although n IC PP value of male patients was slightly higher than female patients the difference was not statistically significant(t=0.577, p=0.565). 2.IC AP and IC PP values in ≤55 age group with gastric adenocarcinoma is slightly lower than >55 years age group, however, n IC AP and n IC PP value was slightly increased. Excluding n IC PP(t=2.122, p=0.037), there was no significant difference(t values were 0.613, 1.066 and 0.693, p>0.05) 3.The maximum tumor diameter and the average value of each spectral CT quantitative parameters in moderately differentiated adenocarcinoma were significantly higher than that in poorly differentiated adenocarcinoma, the difference was statistically significant(P<0.05). 4.There was significant correlation between maximum diameter and n IC PP(r=0.400, p=0.023) in the gastric cardia and fundus. There was significant correlation between maximum diameter and IC AP(r=0.457, p=0.014) and n IC AP(r=0.483, p=0.009) in the gastric body. There was significant correlation between maximum diameter and n IC PP(r=0.413, p=0.032) in the gastric pylorus and antrum. 5.The area under the curve of IC AP and IC AP were 0.687 and 0.755, area under the curve of n IC PP and IC PP were 0.692 and 0.699, respectively; Using n IC AP>0.075 as the threshold value to identify poorly and moderately differentiated adenocarcinoma, its sensitivity was 97.7 %; Using n IC PP>0.305 as threshold, its specificity was 93.2%.Conclusion 1. IC AP and IC PP values in ≤55 age group are slightly lower than those >55 age group, of which the difference of n IC PP is the most obvious. 2. Correlation between the maximum diameter and spectral CT quantitative parameter values of gastric parts is different. It can assess the differentiation degree of gastric adenocarcinoma. 3. Diagnosistic value of n IC, obtained through spectral CT dual-phase enhanced scanning, in evaluating differentiation degree is higher than IC.PartⅢ: The study of spectral CT imaging in evaluating chemotherapy response for gastric adenocarcinoma and diagnostic value in liver perfusion abnormalityObjective 1. To explore the role of spectral CT imaging in evaluating XELOX chemotherapy response for gastric adenocarcinoma. Enhanced spectral CT scans were carried on pre-XELOX chemotherapy and post-therapy for patients with advanced gastric adenocarcinoma. CT quantitative parameter values and their change rates were analyzed to compare with the tumor volume and volume change rate. 2. Utility of spectral CT imaging to assess hepatic microcirculation changes pre-XELOX chemotherapy and post-therapy in patients with advanced gastric adenocarcinoma, and differences of spectral CT quantitative parameters among different chemotherapy response groups, so to explore diagnostic value of spectral CT imaging in evaluating in liver perfusion abnormality.Material and methods Twenty one patients with gastric adenocarcinoma confirmed by pathology at the First Affiliated Hospital of Zhengzhou University form June 2012 to December 2015 were involved in this study, including 11 males and 10 females, aged 30~55 years old, mean(45.329±7.526) years. Enhanced spectral CT scans were done one week before and after chemotherapy, tumor maximum diameter, tumor volume and spectral CT quantitative parameters and their changing rate were measured and analyzed, respectively. Neoadjuvant chemotherapy effect was assessed according to RECIST criteria. Differences of tumor volume, spectral CT quantitative parameter values and their changing rates pre and post therapy and between effective and ineffective groups were analyzed by independent sample t test or paired t-test analysis. Relations of changing rate of tumor volume and spectral CT quantitative parameter values with RECIST criteria standards were analyzed by Pearson correlation method. Diagnostic value of spectral CT quantitative parameters in evaluating neoadjuvant chemotherapy effect for advanced gastric adenocarcinoma was analyzed by Receiver operating characteristic(ROC) analysis, the area under the curve as a criterion to assess its value, and choose the optimal diagnostic threshold, the sensitivity and computing specificity were calculated.Results 1.The maximum diameter of the tumor pre and post chemotherapy in two groups were(15.395±4.025) mm and(12.275±2.352) mm. The maximum tumor diameter of effective group was higher than that of ineffective group, the difference was statistically significant(t=2.241, p=0.037). 2.IC AP, IC PP, IC AP and n IC PP values and tumor volume of effective group were higher than that of ineffective group, difference of IC AP and n IC AP in two groups were most obvious and statistically significant(p<0.05). 3.Spectral CT quantitative parameter values, tumor volume and their change rates post-therapy were lower than those pre-therapy with significant difference(p<0.05). ΔIC AP and ΔV were the most obvious, the difference was statistically significant. 4.There was significant correlation between ΔIC AP, ΔV and RECIST evaluation(P<0.05). Compared with ΔIC AP, ΔV had a slightly better correlation with RECIST evaluation(r=0.817 and 0.663, respectively). 5.When threshold of ΔIC AP in evaluating of chemotherapy response was defined to 0.094, its sensitivity and specificity was 100% and 75%, respectively. When threshold of ?V in evaluation of chemotherapy effect was defined to 0.065, it’s sensitivity and specificity was 100% and 87.5%, respectively. 6.The IC AP and IC PP of liver post chemotherapy were rapidly decreased than that of liver post-therapy. The difference of spectral CT quantitative parameter values between effective group and ineffective group was no statistically significance(P>0.05).Conclusion 1. Spectral CT quantitative parameters, tumor volume and their change rates can help to assess the effect of neoadjuvant chemotherapy for advanced gastric adenocarcinoma. 2. Sensitivity to chemotherapy of gastric adenocarcinomas with relatively lower spectral CT quantitative parameter values is relatively lower than those with abundant blood supply 3. ΔIC AP and ΔV show good correlation with RECIST evaluation. Compared with ΔIC AP, ΔV has a slightly better correlation with RECIST evaluation, suggesting ΔV is better than ΔIC AP in evaluating of the efficacy of chemotherapy. 4. Neoadjuvant chemotherapy affect the liver blood perfusion, to a certain extent, spectral CT quantitative parameter liver is still not an suitable indicator to assess the effect of neoadjuvant chemotherapy. |
PDF Full Text Request