| PART 1Spectral CT imaging in the evaluation of status of lymph nodes in laryngeal and hypopharyngeal squamous cell carcinomaObjective To evaluate the value of spectral CT parameters in the evaluation of status of lymph nodes in laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC).Methods From January 2014 to October 2019,113 lymph nodes from 85 patients with laryngeal and hypopharyngeal squamous cell carcinoma(65 metastasis lymph nodes and 48 nonmetastasis lymph nodes)were retrospectively analyzed.Before treatment,these patients underwent spectral CT scan and were diagnosed as squamous cell carcinoma by puncture or surgical pathology.Iodine concentration(IC),water concentration(WC)and spectral attenuation curve were obtained by spectral CT post-processing software.Normalized iodine concentration(NIC),normalized water concentration(NWC)of lymph nodes,spectral attenuation curve slope of lymph nodes and primary tumors(?HU-L and ?HU-P respectively)and slope ratio(?=?HU-L/?HU-P)in metastasis group and nonmetastasis group were calculated.Independent sample t-test was used to compare the differences of spectral CT parameters between metastatic and nonmetastatic lymph nodes.Paired sample t-test was used to compare the differences of ?HU-L and XHU-P.Using logistic regression analysis to establish diagnostic prediction model combined with spectral CT parameters and short axis diameter.ROC curve was used to analyze the diagnostic efficiency of spectral CT parameters independently and combined with short diameter in the differential diagnosis of lymph node metastasis.The sensitivity and specificity were calculated using the optimal cutoff.The level of significance was defined as P=0.05.Results Eighty-five patients were included in this research,including 50 cases of laryngeal squamous cell carcinoma and 35 cases of hypopharyngeal squamous cell carcinoma with an average age of 56.9±7.8 years(age range 39-72 years).Fifty cases of patients were pathologically diagnosed as lymph node metastasis,and 35 of patients cases did not have lymph node metastasis.The median short axis diameter of 65 lymph nodes in metastasis group was 14 mm(4-62 mm),and that of 48 nonmetastasis lymph nodes was 6 mm(4-11 mm).The area under the curve(AUC)was 0.838(sensitivity 73.8%,specificity 83.3%)when the cut-off of the cross-sectional short axis diameter of lymph node was 8mm.The value of IC,NIC,the spectral attenuation curve slope of lymph nodes and slope ratio in metastasis group were higher than those in nonmetastasis group(all P<0.05).The AUC of spectral attenuation curve slope of lymph nodes,slope ratio,IC,NIC and combined parameters were 0.655(sensitivity 55.4%,specificity 70.8%),0.763(sensitivity 76.9%,specificity 77.1%),0.673(sensitivity 64.6%,specificity 66.7%),0.688(sensitivity 69.2%,specificity 60.4%),0.854(sensitivity 76.9%,specificity 83.3%),respectively.In the ROC curve which combined short axis diameter with spectral attenuation curve slope of lymph nodes,slope ratio,IC and NIC respectively,the AUC was 0.874,0.902,0.877 and 0.855,respectively,the sensitivity was 81.5%,75.4%,80.0%and 73.8%,respectively,the specificity was 89.6%,93.7%,91.7%and 91.7%,respectively.The AUC of short axis diameter combined with spectral CT combined parameters in the diagnosis of lymph node metastasis was 0.913,and the sensitivity and specificity were 83.1%and 93.7%respectively.Conclusion The short axis diameter of lymph nodes combined with spectral CT parameters is helpful to differentiate metastatic lymph nodes from nonmetastatic lymph nodes in LHSCC.PART 2Correlation between quantitative parameters of spectral CT with the expression level of epidermal growth factor receptor in laryngeal and hypopharyngeal squamous cell carcinomaObjective To investigate the correlation between the quantitative parameters of spectral CT and the expression level of epidermal growth factor receptor(EGFR)in laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC)and to evaluate the potential predictive value of the expression level of EGFR.Materials and Methods From January 2014 to December 2019,43 patients who had underwent spectral CT scan and were confirmed LHSCC by biopsy or surgery were retrospectively enrolled.The value of iodine concentration(IC),water concentration(WC),effective atomic number and spectral attenuation curve of the primary tumor of LHSCC were obtained by spectral CT post-processing software,and normalized iodine concentration(NIC),normalized water concentration(NWC)and spectral attenuation curve slope(XHU)were calculated.Independent sample t-test was used to analyze the differences of quantitative parameters of spectral CT of LHSCC with different EGFR expression levels.ROC curve was drawn,and the optimal cut-off was determined.The sensitivity and specificity were calculated using the optimal cut-off.The level of significance was defined as P=0.05.Results EGFR mutations were detected in all 43 LHSCC patients,including 24 cases expressing high levels of EGFR,and 19 cases expressing low levels of EGFR.The value of IC and NIC were statistically different between EGFR high expression group and low expression group(P=0.007,P=0.003).The IC value of the two groups were 2.22±0.63mg/ml and 1.68±0.58mg/ml,respectively,and NIC value of the two groups were 0.31±0.09 and 0.23±0.08,respectively.However,no statistically difference were observed in WC,NWC,?HU and effective atomic number between the two groups(P>0.05).With IC 1.51mg/ml as the cut-off value,the area under the curve(AUC)was 0.730,and the sensitivity and specificity were 95.8%and 47.4%respectively;With NIC 0.26 as the cut-off value,the AUC was 0.781,and the sensitivity and specificity were 87.5%and 68.4%respectively.Conclusion The quantitative parameters of spectral CT are valuable to predict the expression levels of EGFR in LHSCC,and NIC has the highest diagnostic efficiency.PART 3Potential predictive value of spectral CT parameters for recurrence and metastasis of laryngeal and hypopharyngeal squamous cell carcinoma after radiotherapyObjective To investigate the prognostic value of spectral CT parameters in patients with laryngeal and hypopharyngeal squamous cell carcinoma after radiotherapy.Materials and methods From January 2014 to November 2019,51 laryngeal and hypopharyngeal squamous cell carcinoma patients who received radiotherapy in our hospital and underwent spectral CT scan before treatment were retrospectively assessed.The iodine concentration(IC),water concentration(WC),effective atomic number and spectral attenuation curve were obtained by spectral CT post-processing software,and the normalized iodine concentration(NIC),normalized water concentration(NWC)and spectral attenuation curve slope(?HU)were calculated.The gender,age,tumor location,T stage and N stage of patients were recorded.The survival of the patients was followed up.Kaplan Meier survival curve was drawn and log-rank method was used to compare the survival rate.Univariate and multivariate Cox regression analysis were applied to explore the independent prognostic factors of laryngeal and hypopharyngeal squamous cell carcinoma.Results A total of 51 patients with laryngeal and hypopharyngeal squamous cell carcinoma were included,including 5 cases of laryngeal squamous cell carcinoma and 46 cases of hypopharyngeal squamous cell carcinoma.Recurrence and/or metastasis were occurred in 27 cases.The 1 year,2 year and 3 year PFS rate were 79.8%,64.9%and 45.3%,respectively.The 1 year,2 year and 3 year loco-regional control(LRC)rate were 79.8%,67.0%and 49.9%,respectively.Univariate analysis showed that IC(P=0.014),NIC(P=0.019)and XHU(P=0.007)were prognostic factors for PFS,and IC(P=0.014),NIC(P=0.035)and ?HU(P=0.006)were prognostic factors for LRC.Multivariate Cox regression analysis indicated ?HU(PFS:HR=3.053,95%CI:1.364-6.833,P=0.007,LRC:HR=3.723,95%CI:1.452-9.548,P=0.006)was an independent prognostic factor for PFS and LRC.Conclusion The spectral attenuation curve slope(?HU)is an independent prognostic factor for recurrence and metastasis of laryngeal and hypopharyngeal squamous cell carcinoma after radiotherapy,and might be used as a potential prognostic indicator for laryngeal and hypopharyngeal squamous cell carcinoma. |
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