| Part1 Correlations between the iodine value and CT enhancement value of dual-energy CT and the pathological differentiationdegree of advanced gastric adenocarcinoma Objects:To explore the correlations of the iodine value and enhancement value of the dual-energy CT with pathological differentiation degree of advanced gastric adenocarcinoma,and to compare their diagnostic efficacy.Methods:Clinical and Imaging data of 45 patients with pathologically proved advanced gastric adenocarcinoma were retrospectively analyzed,including 18 patients with moderate/highly differentiated adenocarcinoma and 27 patients with poorly differentiated adenocarcinoma.All the subjects underwent the dual-energy CT dual-stage enhancement scan before the surgery.The CT enhancement values in arterial and venous phase(100Kv,140 Kv,0.5 mixed-energy(relative to 120Kv)),iodine concentration(IC)and normalized iodine concentration(NIC)of the carcinoma in each subject were measured,and their correlations with the degree of pathological differentiation were evaluated.For the values with statistical significance,receiver operating characteristic curve(ROC)analysis was further performed to explore their diagnostic efficiency.Results:There were significant differences between the moderate/highly and the poorly differentiated adenocarcinoma in CT enhancement values of 100 Kv arterial phase(74.51±10.70 Hu vs 86.22±21.88 Hu,p=0.036),IC of the arterial phase(1.48 ±0.27mg/ml vs 2.16±0.85 mg/ml,p<0.001),NIC of the arterial phase((4.84±4.14)%vs(21.15 ± 7.54)%,p=0.002),CT enhancement values of 100 Kv venous phase(95.20±8.99 Hu vs 104.04±24.70 Hu,p=0.007),CT enhancement values of 0.5mixed-energy venous phase(79.47±6.61 Hu vs 88.13±14.44 Hu,p=0.006),IC of the venous phase(2.07±0.49mg/ml vs 3.08±0.72mg/ml,p<0.001),and NIC of the venous phase((44.53±6.42)% vs(60.12±6.32)%,p<0.001).ROC curve analysis shows 100 Kv arterial phase(AUC=0.686),100 Kv venous phase(AUC=0.739),0.5mixed-energy venous phase(AUC=0.746),IC arterial phase(AUC=0.823),NIC arterial phase(AUC=0.779),IC venous phase(AUC=0.891),and NIC venous phase(AUC=0.948).And it was most effective to distinguish the pathological differentiation degree of gastric adenocarcinoma when the threshold of the NIC venous phase was set to48%,with a sensitivity of 83.33% and a specificity of 97.84%.Conclusion:The quantitative analysis of IC of dual-energy CT can predict the pathological differentiation degree of advanced gastric adenocarcinoma,with a higher correlation than the CT enhancement values under different tube voltages.And the diagnostic efficiency of NIC of the venous phase is the best.Part2 The diagnostic value of dual-energy CT iodine value in extra-serosal fat invasion of gastric cancerObjective:To investigate the diagnostic value of dual-energy CT extra-serosal iodine value measurement in extra-serosal invasion of gastric cancer.Methods:A retrospective analysis of 42 patients with gastric cancer confirmed by surgery and pathology and with dual-energy CT dual-stage enhancement was performed.Postoperative pathology confirmed that 27 case of the tumor invaded the serosal surface but not invade out(T3 stage).15 cases of the tumor invading out of the serosa(T4 stage).The iodine concentration(IC)and the normalized iodine concentration(NIC)of the serosal were measured in arterial phase and venous phases,and the correlation with extra-serosal invasion was analyzed.Results:Carcinoma infiltrated T3 stage arterial extraserosal IC(0.16±0.15mg/ml),NIC(1.70±1.61%),venous extraserosal IC(0.29±0.21mg/ml),NIC(6.06±4.11)%)with T4 arterial extraserosal IC(0.74±0.20mg/ml),NIC(7.40±1.96%),venous extraserosal IC(1.17±0.21mg/ml),NIC(24.69±4.64%)There were statistical differences(p <0.001).Conclusion:The dual-energy CT iodine value can be used as a reference standard for the extra-serosal invasion of cancer. |
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