| Objective:Through the observation and analysis of the energy spectrum parameters,To preliminarily explore the application value of the energy spectrum CT in evaluating the Pathological Types of Colorectal Cancer and Its Application in the Identification of Ulcerative Colitis.Materials and Method:A total of 63 cases of colorectal disease patients confirmed by colonoscopy or surgicalpathology were enrolled in the study(54 cases of colorectal cancer and 9 cases of ulcerative colitis).According to the pathological findings,they were divided into Mucinous adenocarcinoma group(n=12)and Ulcerative colitis group(n=9)and Colorectal tubular adenocarcinoma group 42 cases: the medium differentiated group(n=25)and the poorly differentiated group(n=17).before the examination,the patient are signed the informed consent,All the patients were undertaken total abdominal scanning,triple-phase enhanced CT scan using single source dual-energy CT by GSI mode,and the monoenergetic images in both artery phase,portal venous phase and vein phase were obtained.All patients had never been treated before they were scanned,Scanning range from the top of the diaphragm to the lower edge of the pubic symphysis,the energy Spectral images were analyzed with GSI ADW4.6 Viewer.The Iodine material density image,Water material density image,histogram feature and scatter plot of each group were obtained during arterial phase,portal venous phase and venous phase,To observe the difference of the spectral HU curve feature of The colorectal tubular adenocarcinoma and mucinous adenocarcinoma,Colorectal cancer and ulcerative colitis and between the medium differentiated adenocarcinoma and poorly differentiated adenocarcinoma in each phase.Then The iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number and the slope rate of the lesions K=(HU40 kev-HU90 kev)/(40-90)of each groups were compared in three phase.All parameters were subjected to independent sample t-test.Finally,the AUC,sensitivity,specificity,optimal diagnostic threshold and Youden index were calculated under the ROC curve of different degrees of differentiation of colorectal tubular adenocarcinoma,and the diagnostic efficacy of each parameter was evaluated.All the data measured for three times and take the average.Results:(1)Using two independent samples t-test method to compare the each two groups.The difference of IC,NIC,effective atomic number in Arterial phase and NIC in Portal vein phase between the colorectal tubular adenocarcinoma group and the mucinous adenocarcinoma group was statistically significant(P <0.05),The IC,NIC and effective atomic number of the mucinous adenocarcinoma group were slightly higher than those of the colorectal tubular adenocarcinoma group in Arterial phase;The IC of mucinous adenocarcinoma group in portal vein phase and venous phase was higher than that in arterial phase,but that is similar between Portal vein phase and venous phase,there was no statistical significance.water concentration of the three groups was no statistically significant difference in three phases.Compared with colorectal cancer group and ulcerative colitis group,the IC of ulcerative colitis group was higher than that of colorectal cancer group in arterial phase,But there was no statistical significance(P = 0.336),The IC,NIC and effective atomic number of ulcerative colitis group were higher than that of colorectal cancer group in other phase(P <0.05).(2)The spectral HU curves of the different pathological types showed gradual decreasing(With the Ke V value decreased during 40 ~ 90 ke V,the HU of the lesion gradually increased),The slope rate of the spectral HU curve is negative,The slope rateof colorectal tubular adenocarcinoma and mucinous adenocarcinoma(-1.54 ±0.84?-1.99 ± 0.35)showed that significant difference during arterial phase(P= 0.01),The absolute value of slope rate of mucinous adenocarcinoma is greater than that of colorectal tubular adenocarcinoma,The energy spectrum HU curve of mucosal adenocarcinoma is located above the colorectal tubular adenocarcinoma,There was no statistically significant difference between portal phase and venous phase.the slope rates between the Colorectal cancer group and the ulcerative colitis group showed That was statistically significant in three phase,The energy spectrum HU curve of ulcerative colitis group is located above the Colorectal cancer.(3)Two independent sample t test methods were used in Comparison of energy spectrum parameters between medium differentiated adenocarcinoma and poorly differentiated adenocarcinoma,The IC,NIC,effective atomic number and spectrum slope rate of the medium differentiated group were higher than those of the poorly differentiated group during arterial phase,those spectrum parameters were statistically significant between the two groups(P<0.05),In the other two phases,the parameters were similar in size,the difference was not statistically significant,and the water concentration had no statistical significance in the three phase.In arterial phase,the ROC AUC of IC,NIC,effective atomic number and spectrum slope were0.723?0.772?0.750 and 0.769,respectively.When its testing threshold were set at more than5.85(100ug/m1),0.08,7.95 and less than-1.04,its sensitivity,specificity to differentiate the stages of colorectal tubular adenocarcinoma were(92.3 %?52.6%),(88.5%?73.7%),(92.3%?68.4%),(73.7%?88.5%).Conclusion:(1)Using IC,NIC,energy spectrum curve slope rate and effective atomic number to identify colorectal tubular adenocarcinoma and mucinous adenocarcinoma,Colorectal cancer and ulcerative colitis is valuable,to a certain extent,it can reflect its pathological features.(2)Water concentration was no statistically significant difference to identificate colorectal tubular adenocarcinoma and mucinous adenocarcinoma,Colorectal cancer and ulcerative colitis.(3)The parameters(IC,NIC,effective atomic number and slope rate of the spectral HU curve)can identify the degree of differentiation of tubular adenocarcinoma during arterial phase,especially NIC has more reliable diagnostic efficacy. |
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