Application Of Volumetric Computed Tomography Spectral Imaging In Cervical Cancer

Objective: To study the feasibility of iodine concentration from volumetric CT Spectral imaging parameters in the diagnosis of cervical cancer.Methods: This study was approved by the local ethical board.A total of 37 patients with cervical cancer diagnosed by the pathological diagnosis were enrolled in the Cancer Hospital of China Medical University from March 2018 to January 2019.All patients underwent pelvic low-dose spectral imaging after injection of contrast media,measured the dose length product(DLP),calculated the effective dose,and collected clinical data.After the images were acquired,the Dual Energy spectrum processing program was used to process the spectral data.Two radiologists measured the iodine concentration(IC)and normalized iodine concentration(n IC)in the external iliac artery,cervical cancer lesions and normal uterine body in the generated iodine map.The measurement of the iodine concentration of cervical cancer lesions is outlined using the maximum area ROI(m ROI)and small circular ROI(s ROI).Compare the measurement consistency between the two physicians;compare the difference between the iodine concentration measured by the two ROI schemes;compare the iodine concentration between the cervical cancer lesions and the normal uterine body;The FIGO staging was used as a standard to study the differences in iodine concentration between early cervical cancer lesions and advanced cervical cancer lesions.The iodine concentration of lesions between different pathological types and different menstrual conditions were compared.Statistical analysis was performed using SPSS 21.0 and Med Calc software.The measurement data are expressed as x?±s.The ICC was used to evaluate the consistency of the measurements,and the Bland-Altman analysis was used to compare the differences between the two radiologists;the Wilcoxon signed rank sum test was used to compare the differences in iodine concentration between different ROIs and cervical cancer lesions.The Mann-Whitney U test was used to compare the iodine concentration between different stages,different pathological types,and different menopausal cervical cancers.The ROC curve was drawn and AUC,sensitivity,and specificity were calculated.Results: All patients had a DLP of 147.10 ± 31.87 m Gy·cm and an effective dose of 1.91 ± 0.41 m Sv.The ICC values of the parameters measured by the two radiologists ranged from 0.897 to 0.981,the mean of the measurement differences were-0.82 to 0.51,and the consistency and reproducibility were good.The iodine concentration measured by the small round ROI(s ROI-IC)in cervical cancer lesions was significantly higher than the iodine concentration(m ROI-IC)measured by the maximum area ROI method.The normalized iodine concentration of the lesions measured by small round ROI(s ROI-n IC)was significantly higher than the normalized iodine concentrations measured by the maximum area ROI method(m ROI-n IC),and the difference was statistically significant(P<0.05).The s ROI-IC(66.45±15.86)and m ROI-IC(46.37±13.80)of cervical cancer lesions were significantly lower than the iodine concentration of uterus(86.68±21.27).The s ROI-n IC(0.41±0.09)and m ROI-n IC(0.29±0.08)of cervical cancer lesions were significantly lower than the normalized iodine concentration of uterus(0.54±0.15),and the difference was statistically significant(P<0.05).the s ROI-IC and s ROI-n IC of early cervical cancer were significantly lower than the s ROI-IC and s ROI-n IC of advanced cervical cancer,the difference was statistically significant(P <0.05),and the AUC of s ROIIC is 0.743,the sensitivity is 73.7%,the specificity is 77.8%;the AUC of s ROI-n IC is 0.678,the sensitivity is 79.0%,specific 61.1%;m ROI-IC and m ROI-n IC have no difference between the early and advanced cervical cancer;iodine concentration were no differences between in the different types of pathology and the different menstrual levels.Conclusion: 1.The iodine concentration and the normalized iodine concentrations of volumetric CT spectral imaging parameters have good measurement stability.2.Advanced cervical cancer tends to have higher iodine value than early cervical cancer,and volumetric CT spectral imaging is feasible in cervical cancer assessment.3.In the application of volumetric CT spectral imaging for the diagnosis of early and advanced cervical cancer,the small ROI method is superior to the largest area ROI method.