| Part one:The value of energy spectrum CT multi-parameter imaging in the diagnosis of differentiation of esophageal carcinomaObjective: To explore the value of energy spectrum CT multi-parameter imaging in preoperative evaluation of differentiation degree of esophageal squamous cell carcinoma by analyzing the multi-parameter characteristics of energy spectrum CT of esophageal squamous cell carcinoma.Methods: 62 patients with esophageal cancer diagnosed by gastroscopy or postoperative pathology were collected.Before operation,plain chest scan of CT and dual-phase enhanced scan of artery and vein were performed.The original data were transmitted to AW4.7 workstation and analyzed by GSI Protocols general software.Single energy map,energy spectrum curve and base material map were obtained,and the CT value,iodine concentration and water concentration under different single energy were measured.The energy spectrum curve was redrawn,and the slope K of the energy spectrum curve and the standardized iodine concentration NIC were calculated.According to the postoperative pathological results,the subjects were divided into two groups according to different degrees of differentiation,namely,moderately differentiated esophageal squamous cell carcinoma group and poorly differentiated esophageal squamous cell carcinoma group.The above energy spectrum parameters between the two groups were statistically analyzed,and the receiver working characteristic(ROC)curve was used to evaluate the efficacy of iodine concentration and standardized iodine concentration NIC in the differential diagnosis of esophageal squamous cell carcinoma with different differentiated degrees,and their sensitivity,specificity and area under the curve were calculated.Results: Among the 62 patients with esophageal squamous cell carcinoma,there were35 cases in high school differentiation group and 27 cases in low differentiation group.General qualitative and quantitative parameters: there was no significant difference in location,age,sex and tumor size between the two groups(P > 0.05).Multi-parameter characteristics of energy spectrum CT: there was significant difference in CT values of esophageal squamous cell carcinoma between arterial phase 40-70 ke V and venous phase 40-100 ke V,and the CT value of low differentiation group was higher than that of high and high differentiation group at the same level,but there was no significant difference between the two groups at arterial phase 80-140 ke V and venous phase110-140 ke V.The energy spectrum curves of arterial and venous phases of esophageal squamous cell carcinoma in both the high and low differentiation groups showed a downward trend,and the esophageal squamous cell carcinoma in the low differentiation group was on the top,and the esophageal squamous cell carcinoma in the high differentiation group was below it.There was a significant difference in longitudinal CT values between the two groups when the Abscissa X-ray energy(ke V)was in the range of 40 to 70 in the arterial phase and in the venous phase when the X-ray energy(ke V)was in the range of 40 to 100.However,the curves of the two groups tended to be close when the Abscissa X-ray energy(ke V)was in the range of 80 to 140 in the arterial phase and in the venous phase when the X-ray energy(ke V)was in the range of 110 to140.There were significant differences in matrix concentration(IC and NIC)and slope K between high and low differentiation groups in arterial phase and venous phase.There was no significant difference in water concentration between the two groups(P > 0.05).ROC curve analysis showed that the AUC of arterial phase matrix concentration(IC and NIC)and venous phase base substance concentration(IC and NIC)for the diagnosis of differentiation degree of esophageal squamous cell carcinoma were 0.66,0.75 and0.69,0.78,respectively.When the threshold of arterial base substance concentration(IC and NIC)is equal to 15.78mg/m L and 0.36 respectively,the sensitivity and specificity are 52%,79% and 70%,84%,respectively.When the threshold of intravenous base substance concentration(IC and NIC)is equal to 23.15mg/m L and 0.59,the sensitivityand specificity are 46%,88% and 75%,80%,respectively.The diagnostic efficiency of NIC in arterial and venous phase was higher than that of IC in arterial and venous phase.Conclusion: The multi-parameter characteristics of energy spectrum CT of esophageal squamous cell carcinoma are different according to the degree of differentiation of esophageal squamous cell carcinoma.Energy spectrum CT multi-parameter imaging can provide imaging basis for preoperative evaluation of differentiation degree of esophageal squamous cell carcinoma.Part two:The value of energy spectrum CT multi-parameter imaging in the diagnosis of metastatic lymph nodes of esophageal carcinomaObjective : To explore the application value of CT energy spectroscopy in the qualitative evaluation of metastatic lymph nodes of differently differentiated esophageal cancer.Methods: The clinical data of 48 patients with esophageal squamous cell carcinoma confirmed by endoscopic pathology were collected.All cases were detected using energy CT chest plain scan and dual-phase enhanced scan before surgery.The short diameter of mediastinal lymph nodes,CT value at 70 ke V arterial and iodine concentration in arterial and venous phases were measured,the standardized iodine concentration was calculated,and which was compared with the postoperative pathological results.Results: Among the 48 patients with esophageal squamous cell carcinoma,32 cases with lymph node metastasis and 16 cases without lymph node metastasis were confirmed by operation and pathology.The postoperative pathological results showed that 79 metastatic lymph nodes were found(including 14 highly differentiated squamous cell carcinoma metastatic lymph nodes,27 moderately differentiated squamous cell carcinoma metastatic lymph nodes and 38 poorly differentiated squamous cellcarcinoma metastatic lymph nodes),and there were 32 non-metastatic lymph nodes.There was no statistical significance in the diagnosis of lymph node metastasis between energy spectrum CT imaging and pathological results after surgery(P > 0.05).The short diameter,CT70 ke V and arterial phase NIC in high and moderate differentiation esophageal squamous cell carcinoma metastatic lymph nodes were higher than those in non-metastatic lymph nodes(P < 0.05).The short diameter,CT70 ke V and arterial phase NIC in low differentiation esophageal squamous cell carcinoma metastatic lymph nodes were higher than those in non-metastatic lymph nodes(P < 0.05).The ROC curve analysis showed that the sensitivity and specificity of the combined of CT70 ke V,standardized iodine concentration and energy spectrum curve slope in arterial phase in the diagnosis of metastatic lymph node of esophageal cancer were 86% and 88%,respectively.Conclusions: The CT energy spectroscopy has important value in qualitative valuating the lymph nodes of differently differentiated esophageal cancer.It is helpful for N staging,clinical diagnosis and choice of treatment option of esophageal cancer. |
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