| Objective To evaluate the diagnostic value of dual source computed tomography(DSCT)energy spectrum quantitative parameters including normalized iodine concentration,40keV-140keV single energy spectrum value,and slope of energy spectrum curve in arterial and venous phase in Lauren classification of gastric cancer.Methods Patients with gastric cancer diagnosed by gastroscopy before operation and Lauren diffuse type and intestinal type diagnosed by pathology were postoperative collected and selected(June 2018-July 2019)for the first time in our hospital.These patients operated within one week underwent CT examination before operation,including 49 cases of multi-slice spiral computed tomography(MSCT)enhanced examination and 61 cases of DSCT enhanced examination.Patients with complete clinical,pathological and imaging data was taken as study group and patients with abdominal pain,normal stomach through gastroscopy and DSCT enhanced examination were taken as control group.The basic clinical and imaging data of 110 patients with gastric cancer(including age,sex,lesion location,lesion size,homogeneous enhancement or not,serosa infiltration or not)were collated and divided into diffuse type group and intestinal type group based on postoperative pathology,while the distribution differences between the two groups were compared by chi-square test.The plain CT value,arterial CT value,venous CT value,arterial CT added value,venous CT added value of patients undergoing MSCT enhanced examination were collected,and the differences of these indexes in diffuse gastric cancer group and intestinal gastric cancer group were statistically analyzed by independent sample T test.Normalized iodine concentration(ANIC/VNIC),40keV-140keV single energy spectrum value in arterial and venous phase and 40keV-70keV slope(λa/λv)of energy spectrum curve in arterial and venous phase of 61 patients with gastric cancer and 25 patients with normal stomach undergoing DSCT enhanced examination were collected as parameters.One-way ANOVA and multiple comparison were used to analyze the differences of the above energy spectrum indexes among normal control group,diffuse group and intestinal group.For statistically different parameters,draw the receiver operating characteristic(ROC)curve of the subjects,analyze their respective diagnostic efficiency.Results Among 110 gastric cancer patients included 54 diffuse and 56 intestinal gastric cancer patients,the proportion of women in diffuse gastric cancer is 42.59%,which is higher than that of 14.29%in intestinal gastric cancer,the difference is statistically significant(χ2=10.884,P=0.001).The proportion of patients<60 years old in diffuse gastric cancer was 51.85%,which was significantly higher than the 16.07%proportion of patients<60 years old in intestinal gastric cancer(χ2=15.767,P=0.000).There was no statistical difference between the two types of gastric cancer in the comparison of the lesion size,the location of the onset,the uniformity of enhancement and serosa infiltration(P>0.05).Among the five CT values of MSCT,only the venous phase CT value had statistical significance between diffuse type group(98.77±16.89)and intestinal type group(87.30± 15.95)(t=2.434,P=0.019).In the DSCT parameters of normal control group,diffuse gastric cancer group and intestinal gastric cancer group,ANIC(18.96±1.76%,21.4±2.22%,20.22±1.64%),VNIC(52.71 ±3.73%,58.31 ±3.49%,55.40±3.70%),λa(-0.265±0.020,-0.315±0.023,-0.301±0.022),λv(-0.285±0.023,-0.362±0.024,-0.337±0.023)were significantly different among normal control group,diffuse gastric cancer group and intestinal gastric cancer group(P<0.05).There was statistical difference among the three groups in the range of 40keV-80keV of the single energy spectrum value(P<0.05),while there was no statistical difference among some groups in the range of 90keV-140keV.The area under the ROC curve for distinguish diffuse gastric cancer from intestinal gastric cancer was calculated,Venous phase CT value of MSCT and ANIC,VNIC,λa,λv of DSCT were respectively 0.668,0.677,0.722,0.674,0.768.When the diagnostic threshold of venous phase slope λv was-0.355,its sensitivity and specificity were 0.643 and 0.848.When VNIC and λv,were combined to distinguish diffuse gastric cancer from intestinal gastric cancer,the area under the curve was 0.819,the sensitivity was 0.929 and specificity was 0.606.Conclusion ① In Lauren classification,diffuse gastric cancer is different from intestinal gastric cancer in terms of gender and age.The proportion of diffuse gastric cancer in young women is higher,and the proportion of intestinal gastric cancer in old men is higher;②MSCT has some value in Lauren classification of gastric cancer;③Several quantitative parameters of DSCT have great value in Lauren classification of gastric cancer.The diagnostic efficiency is better than MSCT. |
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