Value Of Dual?layer Spectral Detector CT In The Diagnosis Of Cervical Cancer

Objective:To investigate the value of dual-layer spectral detector CT energy spectrum images in the detection and staging of cervical cancer.Materials and Methods:Retrospective analysis of 50 patients with first diagnosis of cervical cancer at the First Hospital of Shanxi Medical University from October 2019 to October 2022,all of whom underwent double-detector spectral CT abdominopelvic enhancement scans prior to treatment,48 of whom underwent simultaneous pelvic MRI plain and enhancement scans,and complete histopathological data were obtained.Based on conventional CT and spectral CT 40 ke V lesion CT values,common iliac artery CT values,subcutaneous fat CT values,lesion iodine concentration(IC)and homogeneous aortic iodine concentration were measured quantitatively in 50 patients,and signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)and standardized iodine concentration(NIC)were calculated.The above data were measured in two separate phases,the arterial phase and the venous phase.Subjective evaluation of conventional CT and spectral CT 40 ke V image quality was performed by two abdominal imaging physicians with 15 and 5 years of experience,respectively,applying a 5-point scale.Using pathological examination to confirm clinical FIGO staging as the"gold standard",two senior imaging physicians analysed spectral CT 40 ke V and MRI plain and enhanced scans in a double-blind manner,recording whether the lesions were positive or not,observing the location,size and extent of the tumour in multiple planes for positive lesions,determining whether there was parametrial infiltration,vaginal infiltration and The tumour site,size and extent are observed in multiple planes to determine the presence of parametrial infiltration,vaginal infiltration and lymph node metastasis and to evaluate the staging.The data were first tested for normality(Shapiro-Wilk,SW).Independent samples t-test was used for comparison between groups of quantitative data that conformed to a normal distribution,Wilcoxon rank sum test was used for comparison between groups of data that did not conform to a normal distribution,andχ~2 test was used for qualitative data(%)Comparisons.The Kappa test was used to compare the concordance of spectral CT and MRI examinations with pathological findings.To assess the diagnostic efficacy of IC and NIC in the early and progressive stages of cervical cancer,subject operating characteristic curve(ROC)curves were constructed and the area under the curve(AUC)was calculated,and the differences between AUCs were compared using the De Long test.Results:1.The CT value,SNR and CNR of the lesion on the 40 ke V images in the arterial and venous phases were higher than those on the conventional 120 k Vp PI,and the difference between the two groups was statistically significant(both P<0.001).The subjective image quality scores on the 40 ke V and iodine images were better than those on the conventional CT(both P<0.05).2.The detection rates of MRI and spectral CT for cervical cancer were higher than those of conventional CT,with 91.67%(44/48),81.25%(39/48)and 60.42%(29/48),respectively,and the differences were statistically significant(P<0.05).The diagnostic compliance rate of spectral CT for cervical cancer stage IIB and above(100.00%)was higher than that of MRI(95.65%),and the difference was not statistically significant(P>0.05).The diagnostic compliance rate of MRI for cervical cancer stage IIA and below(80.00%and90.00%)was higher than that of spectral CT(20.00%and 75.00%),and the difference was not statistically significant(P>0.05).MRI was more consistent than spectral CT in diagnosing early(≤stage IIA)and progressive(≥stage IIB)cervical cancer with pathological staging(Kappa value=0.834,P<0.001;Kappa value=0.630,P<0.001).The sensitivity,specificity,and accuracy of spectral CT in the diagnosis of lymph node metastasis in cervical cancer(90.00%,100.00%,94.87%)were higher than those of MRI(65.00%,87.50%,77.27%),and the differences were statistically significant(P<0.05).3.The IC and NIC were higher in the arterial and venous stages of cervical cancer than in the early stages,with a statistically significant difference in IC and NIC in the arterial stage.The ROC curve showed that AUC of NIC in arterial stage diagnosing early and progressive cervical cancer was 0.718(95%[CI]:0.552～0.850),which was higher than that of IC in arterial stage 0.704(95%[CI]:0.536～0.839),and the difference was not statistically significant(Z=0.382,P>0.05),and the arterial phase NIC was better diagnosed.Conclusion:Spectral CT 40 ke V has good SNR and CNR,which combined with iodine map can help to detect cervical cancer lesions,can optimally display cervical cancer lesions and their infiltration range,has advantages in evaluating lymph node metastasis,can improve the accuracy rate of cervical cancer diagnosis and staging,and the spectral CT arterial stage IC and NIC have certain diagnostic value in differentiating early stage and progressive stage of cervical cancer,which can provide scientific imaging basis for clinical treatment decision.