| Objective: To investigate the value of spectral CT 40 ke V imaging to evaluate peritoneal metastasis in advanced epithelial ovarian cancer.Methods: A retrospective analysis was conducted on 32 cases of advanced epithelial ovarian cancer who underwent primary cytoreduction surgery in the First Affiliated Hospital of Dalian Medical University from January 2017 to December 2021.Among them,11 cases were satisfied with primary cytoreduction surgery and 21 cases were not satisfied.Age,histological type,FIGO stage,serum CA-125 level,and serum HE4 level were recorded in satisfied and dissatisfied groups,respectively.All patients underwent abdominal and pelvic GSI CT scan and enhanced scan within 4 weeks before surgery to obtain dynamic enhanced venous phase spectral CT image reconstruction virtual monoenergetic image(VMI)40 ke V and conventional CT image.A senior radiologist read the radiographs by double-blind method,recorded the degree of ascites,refined the anatomical structures of abdominal and pelvic with reference to Sugerbaker peritoneal cancer index(PCI)and performed CT-PCI score,and integrated analysis of upper abdominal CT-PCI score separately.At the same time,CT-PCI scores of all cases were performed by a junior physician referring to the above criteria.Peritoneal metastasis at11 sites(refer to suidan scoring model)were extracted from VMI 40 ke V imaging assessment records of senior doctors.SPSS 27.0 and Medcalc 20.1.0 were used for statistical analysis.To compare the differences of clinical parameters(including age,FIGO stage,histological type,serum CA-125 and HE4 levels),conventional CT radiological parameters(including ascites degree,abdominal and pelvic CT-PCI score,and upper abdominal CT-PCI score)between the satisfactory and unsatisfactory groups for primary cytoreduction surgery in advanced epithelial ovarian cancer.Binary logistic regression was used to analyze the clinical and radiological parameters influencing the outcome prediction of unsatisfactory tumor reduction surgery.Paired sample T-test was used to compare CT-PCI scores of senior physician and junior physician in conventional and VMI40 ke V images.Meanwhile,CT-PCI scores of senior physician and junior physician in conventional and VMI40 ke V CT images were compared,respectively.Receiver operating characteristic curve(ROC)were plotted to evaluate the threshold,specificity and sensitivity of prediction of patients with advanced epithelial ovarian cancer who were not satisfied with primary cytoreduction surgery by conventional CT and VMI 40 ke V CT-PCI scores by two physicians.Univariate logistic regression was used to analyze the factors influencing the unsatisfactory outcome of primary cytoreduction surgery in advanced epithelial ovarian cancer in radiological indicators extracted from suidan score.Results: 32 cases of epithelial ovarian cancer included 27 cases of serous carcinoma,2 cases of mucinous carcinoma and 3 cases of clear cell carcinoma,among which 28 cases were stage III and 4 cases were stage IV.The serum CA-125 level in the satisfied group was lower than that in the unsatisfied group(112 vs.654 u/ml,U=58,P=0.023).The conventional CT-PCI score was lower than that of the dissatisfied group(9.63±3.14 vs.15.23±2.86,t=-5.089,P < 0.001),and the upper abdominal CT-PCI score was lower than that of the dissatisfied group(2 vs.6,U=43,P=0.003).There was no significant difference in age,FIGO stage,histological type and ascites degree between the satisfied group and the dissatisfied group.Conventional CT-PCI score was an independent factor for patients with advanced epithelial ovarian cancer dissatisfied with initial tumor reduction(OR=1.785,95% CI= 1.024-3.111,P=0.041).Conventional CT-PCI scores of senior and junior physicians were lower than VMI 40 ke V(senior: mean difference =-1.81250,t=-6.055,P < 0.001;junior: mean difference =-2.84375,t=-6.989,P < 0.001),the conventional CT-PCI score of junior physician was lower than that of senior physician(mean difference =-1.12500,t=-4.518,P < 0.001).There was no significant difference in VMI 40 ke V CT-PCI score between senior physician and senior physician(mean difference =-0.09375,t=-1.359,P=0.184).The cut-off values of VMI 40 ke V CTPCI scores for predicting unsatisfactory cytoreduction surgery were 14 points,AUC was0.950,sensitivity was 90.48 %,specificity was 81.82 %,95% CI was(0.810 ～ 0.996)for both senior and junior physicians.The cut-off value of conventional CT-PCI score for predicting unsatisfactory cytoreduction surgery was 11 points for both senior and senior physicians.The AUC of conventional CT-PCI for senior physicians was 0.909,sensitivity 85.71%,specificity 81.82%,95% CI(0.753～0.981).The AUC of routine CT-PCI was 0.877,the sensitivity was 76.19%,the specificity was 90.91%,and the 95%CI was(0.712 ～ 0.961).Univariate logistic regression analysis of 11 radiological indicators of VMI 40 ke V showed that subphrenic lesions(OR = 11.33,95% CI =2.036-63.028,P = 0.006),gallbladder fossa and intersegmental fissure of the liver lesions(OR = 11,95% CI = 1.187-101.98,P= 0.035)was the factor influencing the unsatisfactory primary cytoreduction surgery.Conclusion: CT-PCI score is an independent factor for the unsatisfactory outcome of primary cytoreduction surgery in advanced epithelial ovarian cancer.The use of spectral CT 40 ke V reconstructed images showed that senior and junior physicians were equally capable of diagnosing peritoneal metastasis of advanced epithelial ovarian cancer,which could reduce the difference of CT-PCI scores between senior and junior physicians,and improve the diagnostic efficiency of peritoneal metastasis of advanced epithelial ovarian cancer.The subphrenic region above VMI40 ke V image and the peritoneal metastasis of the gallbladder fossa and intersegmental fissure of the liver are the factors influencing the outcome of initial tumor cell reduction in advanced epithelial ovarian cancer. |
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