| PartⅠ Diagnostic value of iodine map and conventional morphological measurements in regional lymphatic metastasis of gastric cancer Objective To evaluate the value of dual-energy CT iodine concentration and overlay combining with conventional morphological measurements in metastatic lymph nodes of gastric cancer.Methods A total of 141 regional lymph nodes were collected from 60 gastric cancer patients who underwent dual-energy CT scan and confirmed by surgery and pathology.The short diameter,length,and CT value,iodine concentration,and overlay value of each lymph node were measured,and the short length ratio and enhanced CT value at the arterial phase and venous phase were calculated.Independent sample t-test was used to compare the short dianeter,short length ratio,CT enhancement values,iodine concentration and overlay values between the two groups.The ROC analysis was used with statistically significant parameters and diagnostic efficacy was calculated with each individual parameter and joint parameters.Results Of the 141 regional lymph nodes,73 were metastatic lymph nodes and 68 were non-metastatic lymph nodes.The iodine concentration,overlay value,short diameter and enhanced CT values of the metastatic lymph node at the arterial phase were(1.64±0.68)mg/m],(29.06±11.42)HU,(7.35±3.38)mm,(26.34±14.98)HU,respectively;while the corresponding values of the non-metastatic lymph nodes were(2.51±0.68)mg/ml,(38.90±14.61)HU,(5.32±1.34)mm,(33.57±15.91)HU,and the difference was statistically significant(all P<0.05).There was no significant difference in short length ratio and the venous phase indicators(P>0.05).The area under the ROC curve(AUC)of the diagnosing lymph node metastasis was 0.708,0.650,0.808,0.695 for short diameter,CT enhancement,iodine concentration,and overlay value at the arterial phase,respectively.Four indicators combining to diagnose lymph node metastasis,the series sensitivity and specificity were 21.9%and 98.5%,and the parallel was 100.0%and 80.9%.Conclusion Multiparameter dual-energy CT combining with conventional morphological measurements can improve the diagnostic efficiency of lymph nodes in gastric cancer and has a role in the differential diagnosis of regional lymph nodes in patients with gastric cancer.Diagnostic value of iodine concentration and overlay value in the differentiation degree of gastric cancer and metastatic lymph nodesobjective To explore the value of iodine concentration and overlay value from dual-energy CT at the arterial phase in the evaluating differentiation degree of gastric cancer and metastatic lymph node.Methods Patients with preoperative dual-energy CT scan and postoperative pathologically confirmed gastric cancer were collected.Iodine concentration and the overlay value of the gastric cancer and metastatic lymph nodes were measured at the arterial phase dual-energy CT images.According to pathological differentiation degree,gastric cancer and metastatic lymph nodes were divided into well-differentiated groups and poorly-differentiated groups.Independent sample t-test was used to compare the differences of iodine concentration and overlay value between the two groups of gastric cancer and metastatic lymph node.ROC was used to calculate test indicators and evaluate its diagnostic efficacy.Results In 46 patients with gastric cancer,15 were well-differentiated and 31 were poorly differentiated.Of the 73 metastatic lymph nodes,24 were well-differentiated and 49 were poorly differentiated.In the poorly differentiated group,the iodine concentration of gastric cancer and metastatic lymph nodes was(2.12±0.72)mg/ml,(1.85±0.67)mg/ml,the overlay value was(37.32±13.18)HU,and(32.24±12.10)HU,which were higher than those of well-differentiated group(all P<0.05).There was no significant difference in iodine concentration and overlay value between the same degree of differentiation of gastric cancer and its metastatic lymph nodes(all P>0.05).The area under the ROC curve(AUC)of iodine concentration in the diagnosis of gastric cancer and lymph node differentiation were 0.799,0.787,respectively,while AUC of overlay value in the diagnosis of gastric cancer and lymph node differentiation was 0.745,0.733,respectively.Conclusion The iodine concentration and overlay value at the arterial phase has a role in evaluating the differentiation degree of gastric cancer and metastatic lymph nodes,.Part Ⅲ To analyse the clinicopathological factors influencing lymph node metastasis of gastric cancerObjective To explore the clinicopathological factors affecting lymph node metastasis(LNM)in gastric cancer(GC)and to provide reasonable therapy.Methods The clinicopathological data of 311 gastric cancer patients undergoing surgical operation in the First Affiliated Hospital of Kunming Medical University from January 2013 to December 2017 were retrospectively analyzed.Such as gender,age,location,size,macroscopic type,depth of invasion,degree of differentiation,Lauren classification,neural invasion,vascular invasion,Her-2.Lymph node metastasis group(202 cases)and non-metastatic group(109 cases)were classified.Chi-square test and binary logistic regression model were used to evaluate the clinicopathological factors of LNM.Results LNM was observed in 202 of 311 patients(65.0%),of which 7(16.3%)in 43 T1 phase,20(48.8%)in 41 T2 phase,65(68.4%)in 95 T3 phase and 110(83.3%)in 132 T4 phase.Univariate analysis showed that gender,tumor size,depth of invasion,degree of differentiation,Lauren classification,nerve invasion,and vascular invasion were statistically related with LNM in gastric cancer patients(all P<0.05).Multivariate analysis showed that the depth of invasion(P=0.001,OR=1.772),degree of differentiation(P=0.018,OR=2.113),nerve invasion(P=0.045,OR=1.999),and vascular invasion(P=0.001,OR=2.717)were independent risk factors for LNM(all P<0.05).Conclusion LNM in GC is mainly correlated with depth of invasion,degree of differentiation,nerve invasion,vascular invasion. |
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