| Part One Application of one-step enhancement and perfusion imaging in the differential diagnosis of T3 and T4a staging gastric cancerObjective:To investigate the value of one-step enhancement and perfusion imaging in the differential diagnosis of T3 and T4a staging gastric cancer and further explore the correlation between clinicopathological features and T staging.Materials and Methods:The institutional review board of the first affiliated hospital of Zhengzhou university approved this prospective study and informed consent was obtained from all participants.Sixty-patients with gastric cancer confirmed by pathology?men,n=46;women,n=14;age range,3279 years;median age 62 years?underwent one-step enhancement and perfusion imaging with GE Revolution CT from December 2016 to December 2017 were prospectively selected in this study,and within two weeks after scanning,they were performed surgery.All the images were analyzed on the workstation of ADW4.6 and all measurements were performed on the CT Perfusion 4D-Body Tumor and Reformat software.Blood flow?BF?,blood volume?BV?,mean transit time?MTT?,time to peak?TTP?,capillary permeability surface area product?PS?,the maximum CT value of 22 pass images(CTMAX)and the CT values in non-enhanced scan(CTNON),arterial phase(CTAP)and portal venous phase?CTPVP?of gastric cancer lesions were measured and the CT value difference between non-contrast and arterial(?AP),portal venous phase(?PVP)and CTMAX??MAX?were calculated.At the same time,the clinicopathological features of gastric cancer[age,gender,location,Lauren classification,differentiation,lymphovascular invasion?LVI?,lymph node metastasis?LNM?,carcinoembryonic antigen?CEA?,carbohydrate antigen 125?CA125?and carbohydrate antigen 724?CA724?]were recorded.All CT-derived parameters were compared with two sample t test and Mann-Whitney U test,followed by receiver operator characteristics?ROC?analysis to determine the area under the curve?AUC?,diagnostic efficiency,cut-off,sensitivity and specificity of the corresponding parameters.Correlation analysis was used to analyze the clinicopathological features of patients and T staging.Results:Among 60 patients with gastric cancer,16 cases?14 men and 2 women?and 44cases?32 men and 12 women?were diagnosed as T3 and T4a staging cancers by the surgical pathology examination,respectively.There were 36 cancers located in upper1/3,10 located in middle 1/3,12 located in lower 1/3,2 located above 2/3 regions.The number of patients with intestinal type,diffuse type and mixed type was 15,30and 15 cases,respectively.There were 17 cases of well and moderately differentiated,43 cases of poorly differentiated;40 cases with LNM and 20 cases without LNM;38patients with LVI and 22 patients without LVI.The number of patients who with elevated CEA,CA125,CA724 was 22,8 and 8 cases,respectively.T3 staging and T4a staging showed significant difference in PS,CTAP,CTPVP,?AP and?PVP?Z=-2.776--2.174,all P<0.05?,no significant difference in BF,BV,MTT,CTMAX,CTNON,?MAX?t=-0.534-1.599,Z=-0.502,all P>0.05?.The AUCs of PS,CTAP,CTPVP,?AP,and?PVP were 0.685,0.730,0.720,0.730 and 0.736,respectively.?PVPVP and the combination of PS and CTAP predicted T4a staging with AUC 0.736?cut-off 38.1HU,sensitivity,88.6%;specificity,62.5%?,AUC 0.793?sensitivity,77.3%;specificity,75.0%?,respectively.Further results showed no correlation between T staging and all the above clinicopathological characteristics.Conclusion:1.The parameters(PS,CTAP,CTPVP,?AP,?PVP)derived from one-step enhancement and perfusion imaging provides a noninvasive method to the differential diagnosis of T3 and T4a staging gastric cancer,?PVP,and PS combined with CTAPP have a higher diagnostic performance.2.There was no correlation between T staging and age,gender,location,Lauren classification,differentiation,LVI,LNM,CEA,CA125 and CA724.Part Two One-step Enhancement and Perfusion imaging: Preoperative evaluating the lymphovascular invasion and lymph node metastasis in gastric cancerObjective: To investigate the value of one-step enhancement and perfusion imaging in the diagnosis of lymphovascular invasion?LVI?,lymph node metastasis?LNM?in gastric cancer and further explore the correlation between clinicopathological characteristics and LVI,LNM.Materials and Methods: The institutional review board of the first affiliated hospital of Zhengzhou university approved this prospective study and informed consent was obtained from all participants.Ninety-two patients with gastric cancer confirmed by pathology?age range,3279 years;median age,60 years?underwent one-step enhancement and perfusion imaging with GE Revolution CT from December 2016 to December 2017 were prospectively selected in this study,and within two weeks after scanning,they were performed surgery.All the images were analyzed on the workstation of ADW4.6 and all measurements were performed on the CT Perfusion 4D-Body Tumor and Reformat software.Blood flow?BF?,blood volume?BV?,mean transit time?MTT?,time to peak?TTP?,capillary permeability surface area product?PS?,the maximum CT value of 22 pass images?CTMAX?and the CT values in non-enhanced scan?CTNON?,arterial phase?CTAP?and portal venous phase?CTPVP?of gastric cancer lesions were measured and the CT value difference between non-contrast and arterial??AP?,portal venous phase??PVP?and CTMAX??MAX?were calculated.At the same time,the clinicopathological characteristics of gastric cancer [age,gender,location,Lauren classification,differentiation,T staging,carcinoembryonic antigen?CEA?,carbohydrate antigen 125?CA125?and carbohydrate antigen 724?CA724?] were recorded.All CT-derived parameters were compared with two sample t test and Mann-Whitney U test,followed by receiver operator characteristics?ROC?analysis to determine the area under the curve?AUC?,diagnostic efficiency,cut-off,sensitivity and specificity of the corresponding parameters.Correlation analysis was used to analyze the clinicopathological characteristics of patients and LVI,LNM.Results: 92 patients?68 men and 24 women?with gastric cancer were confirmed by the surgical pathology examination,and 44 patients with LVI while 48 patients without LVI,56 cases with LNM and 36 cases without LNM.There were 52 cancers located in upper 1/3,14 located in middle 1/3,24 located in lower 1/3,2 located above 2/3 regions.The number of patients with intestinal type,diffuse type and mixed type was 27,43,and 22 cases,respectively.There were 33 cases of well and moderately differentiated,59 cases of poorly differentiated;10 cases with T1 staging,22 cases with T2 staging,16 cases with T3 staging,and 44 cases with T4 a staging.The number of patients who with elevated CEA,CA125,CA724 was 26,8 and 12 cases,respectively.The group of positive LVI and the group of negative LVI showed significant difference in BF,MTT,PS,CTMAX,CTPVP,?MAX and ?PVP?Z=-5.683--4.225,t=7.248,all P<0.05?,no significant difference in BV,TTP,CTNON,CTAP,?AP?Z=-1.669--0.805,all P>0.05?.The AUCs of BF,MTT,PS,CTMAX,CTPVP,?MAX and ?PVP were 0.844,0.843,0.828,0.776,0.756,0.810 and 0.756,respectively.With the cut-off value of 68.2s,BF predicted the LVI with a sensitivity and specificity of 86.4% and 70.8%,respectively.T staging,LNM and CA724 were associated with LVI in gastric cancer?all P<0.05?,while age,gender,location,Lauren classification,differentiation,CEA and CA125 were not associated with LVI?all P> 0.05?.The group of positive LNM and the group of negative LNM showed significant difference in MTT and PS?Z=-4.697,-4.705,all P<0.05?,and no significant difference in BF,BV,CTAP,CTPVP,?AP,?PVP,CTMAX,CTNON and ?MAX?Z=-1.649--0.096,t=-0.552,0.145,all P>0.05?.The AUCs,cut-off value,sensitivity and specificity of MTT and PS were 0.791,12.1s,67.9%,86.1% and 0.792,16.5 ml/100g·min,80.4%,72.2%,respectively.The location,T staging,LVI and CEA were associated with LNM?all P<0.05?,while age,gender,Lauren classification,differentiation,CA125 and CA724 were not associated with LNM?all P> 0.05?.Conclusion: 1.The parameters?BF,MTT,PS,CTMAX,CTPVP,?MAX,?PVP?derived from one-step enhancement and perfusion imaging provides a noninvasive method to predict LVI,especially BF.T staging,LNM and CA724 were associated with LVI in gastric cancer.2.The parameters?MTT and PS?derived from one-step enhancement and perfusion imaging provides a noninvasive method to predict LNM.The location,T staging,LVI and CEA were associated with LNM in gastric cancer. |
PDF Full Text Request