| Part ?The value of dual energy CT in evaluating the pathological differentiation of laryngeal cancerObjective:To investigate the value of dual-energy CT in evaluating the pathological differentiation of laryngeal cancer.Methods:92 patients with laryngeal cancer were underwent conventional CT plain scan and DECT enhancement scan(in arterial phase and venous phase)of larynx from September 2016 to November 2019 and confirmed by pathology.According to pathological results,the patients were divided into well differentiated(31 cases),moderately differentiated(38 cases)and poorly differentiated(23 cases).Iodine concentration,Normalized iodine concentration,Overlay value and the slope of spectral curve in arterial phase and venous phase in three groups were measured and compared.Spearman rank sum test was used to evaluate the correlation between quantitative parameters of dual-energy CT and the differentiation of laryngeal cancer.The quantitative parameters of laryngeal cancer with different degrees of differentiation were compared by One way ANOVA,pairwise comparison between groups using LSD-t test.The ROC curve was drawn to analyze the effectiveness of each parameter in differentiating the differentiation of laryngeal cancer,and to calculate the areas under the curve(AUC),yoden index,the best diagnostic threshold,Sensitivity and specificity.Results:There was a negative correlation between Iodine concentration,Normalized iodine concentration,Overlay value and the slope of spectral curve in arterial phases and venous phases and the degree of differentiation(r values were-0.511,-0.311,-0.346,-0.460 in arterial phases,-0.402,-0.271,-0.431,-0.494 in venous phases,P<0.05);The differences of Iodine concentration,Normalized iodine concentration,Overlay value and the slope of spectral curve in arterial and venous phases of laryngeal cancer with different differentiation were statistically significant(P<0.05);The Iodine concentration,Normalized iodine concentration,Overlay value and the slope of spectral curve in arterial and venous phases of poorly differentiated laryngeal cancer were higehr than well differentiated laryngeal cancer and moderately differentiated laryngeal cancer(P<0.05);the slope of spectral curve in venous phases of moderately differentiated laryngeal cancer was higher than well differentiated laryngeal cancer(P<0.05),the remaining parameters were not statistically significant(P>0.05).ROC curve showed the slope of spectral curve in arterial phase had the largest AUC(0.87,0.78,respectively)for distinguish well differentiated and poorly differentiated laryngeal cancer,moderately differentiated and poorly differentiated laryngeal cancer.The sensitivity were 73.9%and 73.9%,specificity were 96.8%and 76.3%;the slope of spectral curve in venous phase had a AUC of 0.69 to distinguish well differentiated and moderately differentiated laryngeal cancer,sensitivity and specificity were 65.8%,71.0%Conclusion:The quantitative parameters of dual-energy CT iodine diagram and the energy spectrum curve can reflect the degree of differentiation of laryngeal cancer to some degree.Among them,the slope of spectral curve in arterial phase has the highest diagnostic efficiency.Part ?The value of dual-energy CT combining with the ratio of short to long diameter in the diagnosis of metastatic lymph nodes of laryngeal cancerObjective:To investigate the value of dual-energy CT combining with the ratio of short to long diameter in the diagnosis of metastatic lymph nodes of laryngeal cancer.Methods:39 patients with laryngeal cancer were underwent conventional CT plain scan and DECT enhancement scan(in arterial phase and venous phase)of larynx from October 2015 to November 2019 and confirmed by pathology.According to pathological results,103 lymph nodes were devided into metastasis group(46 cases)and non-metastasis group(57 cases).Independent sample t-test was used to compare the differences of Iodine concentration,Normalized iodine concentration and the slope of spectral curve(in arterial phase and venous phases),short diameter and the ratio of short to long diameter between metastatic and non-metastatic lymph nodes.The ROC curve was drawn to analyze the effectiveness of each parameter in diagnosising metastatic lymph nodes of laryngeal cancer,and to calculate the areas under the curve(AUC),optimal diagnostic threshold,yoden index,the best diagnostic threshold,sensitivity,specificity,positive predictive value,negative predictive value and accuracy.The ratio of short to long diameter of lymph nodes were combined with the parameters of dual-energy CT to diagnose the metastatic lymph nodes of laryngeal cancer.Results:The short diameter and the ratio of short to long diameter of metastatic lymph nodes were larger than non-metastatic lymph nodes(P<0.05).The Iodine concentration,Normalized iodine concentration and the slope of spectral curve in arterial and Iodine concentration,the slope of spectral curve in venous phases of metastatic lymph nodes were larger than non-metastatic lymph nodes(P<0.001),while the difference of Normalized iodine concentration in venous phases was not statistically significant(P=0.086).The Iodine concentration and the slope of spectral curve(in arterial and venous phases),Normalized iodine concentration(in arterial phases)combining with the ratio of short to long diameter of lymph nodes have improved the AUC,sensitivity,specificity and accuracy in diagnosing metastatic lymph nodes.The slope of spectral curve in venous phase combining with the ratio of short to long diameter had the highest AUC(0.952),the sensitivity,specificity and accuracy were 95.7%,87.7%,91.3%.Conclusion:The dual-energy CT iodine diagram and energy spectrum curve-related quantitative parameters combining with the ratio of short to long diameter of the lymph nodes have certain value in the diagnosis of metastatic lymph nodes of laryngeal cancer.Part ?To investigate the risk factors of clinical and pathological influencing lymph node metastasis of laryngeal cancer.Objective:To explore the risk factors of clinical and pathological affecting lymph node metastasis of laryngeal cancer.Methods:The clinical and pathological data of 1 14 patients with laryngeal cancer who underwent surgical treatment in our hospital from July 2013 to November 2019 were retrospectively analysed.Gender,age,course of disease,tumor classification,T stage,tumor thickness and degree of differentiation were included.According to pathological results,the patients were divided into metastatic group(56 cases)and non-metastatic group(58 cases).The univariate analysis was used to analyze the clinical and pathological characteristics of the two groups,and the binary logistic regression model was used to analyze the risk factors of lymph node metastasis of laryngeal cancer.Results:Cervical lymph node metastasis was found in 56 patients.Univariate analysis showed that the classification,thickness,T stage and degree of differentiation of laryngeal cancer were related with cervical lymph node metastasis of laryngeal cancer(P<0.05).Multivariate analysis showed that classification and tumor thickness were independent risk factors for lymph node metastasis(P<0.05).Conclusion:Lymph node metastasis of laryngeal cancer are correlated with tumor classification and thickness. |
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