| Part one Evaluating the differentiation state of esophageal squamous carcinoma with the Spectral CT imaging in preoperativeObjective Through analysis the spectrum CT parameters of esophageal squamous carcinomas,to investigate the gem preoperative CT spectral imaging to evaluate the degree of differentiation of esophageal squamous carcinoma in preoperative.Methods 113 cases of patients was collected who were diagnosed esophageal cancer by endoscopic or surgical pathology, the conventional CT scanning of chest and abdominal, the single-phase enhanced spectral CT scanning of chest and the dual-phase enhanced spectral CT scanning of abdominal were performed on all the patients in preoperative. The original data of all the patients were transferred to AW4.5 professional workstations, the lesions of iodine concentration, water concentration, the mean CT value of monochromatic images 40 ~ 140 ke V(10 ke V) and the spectral CT curves were obtained by GSI View analysis software, the lesions of standardized iodine concentration(NIC) and the slope of spectral curve K were obtained by calculated, namely, NIC=(the lesions of iodine concentration/the aorta of iodine concentration with the same level of the lesions), K=( the CT value of 40 ke V-the CT value of 100 ke V)/(100-40). The object of study was divided into three groups according to the pathological findings, respectively, there were poorly differentiated squamous carcinoma, moderately differentiated squamous carcinoma and well differentiated squamous carcinoma. The spectrum parameters between study groups were performed on statistically analyzed, and were compared with pathological findings. The ROC curves were generated to assess differential diagnosis efficacy of the iodine concentration and the standardized iodine concentration(NIC),which in the degree of differentiation of esophageal cancer, and respectively calculate the sensitivity, specificity and area under the curve(AUC).Results In 113 cases of patients, there were 24 poorly differentiated squamous carcinoma, 60 moderately differentiated squamous carcinoma and 29 well differentiated squamous carcinoma. General parameters characteristics: the age, gender ratio, disease location and size of different degree of differentiation of esophageal squamous carcinomas were no significant difference(P> 0.05). Spectrum characteristic parameters: there were statistical differences of the mean CT value of monochromatic images 40~80 ke V between poorly and moderately differentiated squamous carcinoma(P<0.05),but were not different in other ke V(P>0.05);There were statistical differences of the mean CT value of monochromatic images 40~100 ke V between poorly and well differentiated squamous carcinoma(P<0.05),but were not different in other ke V(P>0.05);There were statistical differences of the mean CT value of monochromatic images 40~50 ke V between moderately and well differentiated squamous carcinoma(P<0.05),but were not different in other ke V(P>0.05).Statistical differences of iodine concentration, NIC and the slope of spectral curve K were found between poorly and moderately differentiated squamous carcinoma, between poorly and well differentiated squamous carcinoma(P<0.05), but were not different in moderately and well differentiated squamous carcinoma(P>0.05); The water concentration did not show any statistically significant difference among three groups(P>0.05). According to the ROC, the diagnostic performance of NIC was higher than the iodine concentration whether between in poorly and moderately differentiated squamous carcinoma or between in poorly and well differentiated squamous carcinoma.Conclusion Different degree of differentiation of esophageal squamous carcinomas have different characteristic parameters and spectral curve, so the spectrum CT can provides a new imaging method for evaluation on the differentiation state of esophageal squamous carcinoma.Part two The application research of spectral CT imaging in lymph node metastasis of esophageal carcinoma in preoperativeObjective By applying the spectral CT imaging technology to assess the lymph node metastasis of esophageal carcinoma in preoperative, to investigate the diagnostic value of spectrum CT in esophageal cancer lymph node metastasis before operation.Methods 113 cases of patients was collected who were diagnosed esophageal cancer by endoscopic or surgical pathology. The conventional CT scanning of chest and abdominal, the single-phase enhanced spectral CT scanning of chest and the dual-phase enhanced spectral CT scanning of abdominal were performed on all the patients in preoperative. The images of esophageal lesions and lymph nodes were observed and analyzed in the arterial phase. The short diameter value of lymph nodes of the corresponding regional was measured on single-energy 70 ke V mono image,When the lymph nodes, short diameter> 5mm of tracheoesophageal groove side and the lymph nodes, short diameter>10mm of the rest of the regions and the abdominal cavity were diagnosed metastatic lymph nodes, this method is the standard definition of lymph node metastasis of conventional CT. In this study, the standard for the definition of lymph nodes metastasis of spectral curves was: using GSI View analysis software in the arterial phase, the spectrum attenuation curves of esophageal lesions and lymph nodes of corresponding regional were obtained respectively. The lymph nodes were considered metastatic if the two spectral curves take shape identical or roughly overlap.With pathological findings of postoperative and treatment effect as a diagnostic gold standard, comparative analysis of the two methods for determining the value of lymph node metastasis in esophageal cancer diagnosis.Results In 113 cases of patients, there were 41 cases with lymph node metastasis. Thenumber of lymph node dissection was 259 in this 41 cases of esophageal cancer.Among them, there were 113 metastatic lymph nodes and 146 non-metastatic lymph nodes which were confirmed by pathology or clinical. The accuracy, sensitivity and specificity of spectral curves respectively were 86.87%,83.19% and 89.73%, and the positive predictive value, negative predictive value and Younden index respectively were 86.24%, 87.33% and 0.729. The accuracy, sensitivity and specificity of conventional CT method respectively were 71.81%, 54.87% and 84.93%, and the positive predictive value, negative predictive value and Younden index respectively were 73.81%, 70.86% and 0.398. The diagnostic value of the spectral curves is higher than traditional CT method for esophageal cancer lymph node metastasis, and the differences were statistically significant(P<0.05).Conclusion Gemstone CT spectrum curves has high diagnostic value, and it,s diagnostic accuracy is higher than conventional CT method for lymph node metastasis of esophageal cancer in preoperative. It can provides a reference for the development of clinical programs. |
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