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目的探讨单源双能CT碘基图对早期胃癌(EGC)的诊断价值。方法回顾性分析27例经手术病理证实为EGC的患者资料,所有患者均于术前行单源双能CT能谱成像(GSI)模式三期动态增强扫描,对三期增强图像进行碘-水配对基物质分离获得碘基图,并经后处理生成各期碘伪彩图(IPCM)。由两位观察者依据手术记录所示病灶位置对三期IPCM病灶检出情况进行评分,对评分结果的一致性进行Kappa检验,并计算各期病灶检出率,采用卡方检验比较。由两位观察者分别测量各期IPCM中病灶、正常胃壁以及同层主动脉的碘浓度,对两位观察者测量结果的一致性进行组内相关系数(ICC)检验,并计算病灶和正常胃壁的标准化碘浓度(NIC),采用配对样本t检验比较各期IPCM中病灶和正常胃壁NIC间的差异。结果两位观察者对各期IPCM病灶检出的评分结果一致性均很好(Kappa>0.80),动脉期、静脉期及平衡期IPCM对病灶的检出率分别为81.48%、55.56%及14.81%,各期之间检出率比较均有统计学意义(P<0.05)。两位观察者对各期IPCM中病灶、正常胃壁以及同层主动脉碘浓度测量结果的一致性均很好(ICC>0.75),动脉期、静脉期及平衡期IPCM的病灶和正常胃壁的NIC分别为0.14±0.04和0.08±0.03,0.42±0.12和0.32±0.10,0.44±0.10和0.42±0.11,动脉期和静脉期病灶与正常胃壁NIC间差异均有统计学意义(t值分别为11.425和6.240,均P<0.05),平衡期病灶与正常胃壁NIC间差异无统计学意义(t=2.007,P=0.055)。结论单源双能CT碘基图可以定量诊断EGC,动脉期IPCM对EGC的检出率高,具有较大临床价值。
Objective To investigate the diagnostic value of single-source dual-energy CT iodine mapping in early gastric cancer (EGC). Methods The data of 27 patients with EGC confirmed by surgery and pathology were retrospectively analyzed. All patients underwent three-phase dynamic contrast-enhanced single-source dual-energy computed tomography (GSI) The paired-base material was separated to obtain the iodine-base map, which was post-processed to generate IPCM. Two observers scored the location of the third stage IPCM lesion according to the location of the lesion indicated by the surgical record, and performed Kappa test on the consistency of the score. The detection rate of each lesion was calculated and compared by chi-square test. Two observers measured iodine concentrations in lesions, normal gastric wall and aorta in each stage of IPCM respectively. The consistency of measurement results between two observers was tested by ICC, and the lesions and normal gastric wall were calculated The standardized iodine concentrations (NICs) were compared using the paired sample t-test to compare the differences between the lesions in IPCM and normal NICs in each phase. Results The two observers had good agreement (Kappa> 0.80) for the detection of IPCM lesions. The detection rates of IPCM in the arterial phase, venous phase and balance period were 81.48%, 55.56% and 14.81 %, The detection rate between the stages were statistically significant (P <0.05). The two observers had good agreement (ICC> 0.75) for the measurement of iodine concentrations in the lesions, normal gastric wall, and the aorta of the same phase in each stage of IPCM. The lesions of the IPCM in the arterial phase, venous phase, and balance period, 0.14 ± 0.04 and 0.08 ± 0.03, 0.42 ± 0.12 and 0.32 ± 0.10, 0.44 ± 0.10 and 0.42 ± 0.11, respectively. The difference between arterial phase and venous phase lesions and normal gastric wall NIC were statistically significant (t = 11.425 and 6.240, all P <0.05). There was no significant difference between normal control and normal control (t = 2.007, P = 0.055). Conclusion Single-source dual-energy CT iodine mapping can diagnose EGC quantitatively. IPCM in arterial phase has high detection rate of EGC and has great clinical value.