Value of multi-slice spiral CT-based regression model in preoperative diagnosis of pericolonic tumor deposits in patients with colorectal cancer
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摘要:
目的 探究结直肠癌患者癌旁肿瘤沉积(TD)多层螺旋CT(MSCT)表现及术前诊断价值。 方法 选择2018年12月~2021年12月医院收治的63例结直肠癌存在TD患者为TD组、52例结直肠癌出现淋巴结转移患者为淋巴结转移组，对两组患者相关资料进行回顾性分析。患者均于术前接受MSCT检查，分析TD与淋巴结转移患者MSCT表现及其在患者TD病情诊断中价值。 结果 TD患者病灶较大，形态多为不规则，与附近组织界线不清晰，平扫密度不均匀，增强扫可见均匀显著强化，强化程度与原发肿瘤相近，动脉增强扫显示为边界强化，少量病灶可以观察到液化坏死；淋巴结转移患者病灶较小，形态规则，多为圆形或者椭圆形，与附近组织比较边界相对清晰，密度相对均匀。TD组与淋巴结转移组患者病灶密度、边界、形状、长短径之比、平扫CT值、动脉期强化CT值差异有统计学意义(P < 0.05)；多元Logistic回归分析显示，长短径之比、平扫CT值、动脉期强化CT值与TD有关(P < 0.05)，以此构建Logistic回归模型公式为Logit (P)=65.212-6.001×长短径之比-0.315×平扫CT值-0.333×动脉期强化CT值。ROC曲线显示，长短径之比、平扫CT值、动脉期强化CT值用于TD诊断曲线下面积值分别为0.836、0.832以及0.878，回归模型曲线下面积值为0.979。 结论 MSCT检查可以为结直肠癌TD诊断提供有效影像学依据，基于MSCT回归模型有助于提高TD诊断价值。 Abstract:Objective To analyze the multi-slice spiral CT (MSCT) findings of pericolonic tumor deposits (TD) in patients with colorectal cancer, and its value in preoperative diagnosis. Methods The relevant data of 63 colorectal cancer patients with TD (TD group) and 52 colorectal cancer patients with lymph node metastasis (lymph node metastasis group) who were admitted to the hospital from December 2018 and December 2021 was retrospectively analyzed. All patients received MSCT examination before operation. MSCT findings of patients with TD and lymph node metastasis, and the value of MSCT in the diagnosis of TD were analyzed. Results The lesions in patients with TD were large, with irregular shapes, unclear boundaries with surrounding tissues, and uneven density on plain scan. Enhanced scan showed significant homogeneous enhancement which was similar to that of primary tumor. Arterial enhanced scan showed edge enhancement with liquefactive necrosis in a small amount of lesions. The lesions in patients with lymph node metastasis were small, with regular shape, mostly round or oval, relatively clear boundaries with surrounding tissues, and relatively uniform density. There were statistically significant differences in lesion density, boundary, shape, long-to-short diameter ratio, plain scan CT values, and arterial phase enhanced CT values between the TD group and the lymph node metastasis group (P < 0.05). Multivariate logistic regression analysis showed that long-to-short diameter ratio, plain scan CT value, and arterial phase enhanced CT value were related to TD (P < 0.05). The logistic regression model was constructed: Logit(P)=65.212-6.001×long-to-short diameter ratio-0.315×plain scan CT value-0.333×arterial phase enhanced CT value. The ROC curve showed that the area under the curve values of long-to-short diameter ratio, plain scan CT value, and arterial phase enhanced CT value to diagnose TD were 0.836, 0.832 and 0.878, respectively. The area under the curve of the regression model was 0.979. Conclusion MSCT examination provides an effective imaging basis for the diagnosis of TD in colorectal cancer. The MSCT-based regression model is helpful for the diagnosis of TD. -
Key words:
- colorectal cancer /
- pericolonic tumor deposits /
- multi-slice spiral CT /
- regression model /
- diagnosis
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图 3 MSCT表现、CT参数对于TD诊断价值分析的ROC曲线
Figure 3. ROC curve analysis of the value of MSCT findings and CT parameters in the diagnosis of TD.
表 1 TD组与淋巴结转移组患者MSCT表现与CT测定参数比较
Table 1. Comparison of MSCT findings and CT parameters between TD group and lymph node metastasis group
指标 TD组(n=63) 淋巴结转移组(n=52) t/χ2 P 病灶密度[n(%)] 5.443 0.020 均匀 25(39.68) 32(61.54) 不均匀 38(60.32) 20(38.46) 边界[n(%)] 5.441 0.020 清晰 30(47.62) 36(69.23) 不清晰 33(52.38) 16(30.77) 形状[n(%)] 8.720 0.003 规则 18(28.57) 29(55.77) 不规则 45(71.43) 23(44.23) 液化坏死区[n(°%)] 2.255 0.133 有 28(44.44) 16(30.77) 无 35(55.56) 36(69.23) 平均径(cm, Mean±SD) 1.06±0.25 0.99±0.28 1.415 0.160 短径线(cm, Mean±SD) 1.16±0.21 1.12±0.24 0.953 0.343 长径线(cm, Mean±SD) 1.31±0.32 1.24±0.29 1.218 0.226 长短径之比(Mean±SD) 1.06±0.15 1.39±0.24 8.995 < 0.001 平扫CT值(Hu, Mean±SD) 26.94±6.23 18.15±5.19 8.111 < 0.001 静脉期强化CT值(Hu, Mean±SD) 48.26±10.58 44.81±9.62 1.813 0.073 动脉期强化CT值(Hu, Mean±SD) 29.55±6.76 21.64±5.29 6.876 < 0.001 TD: 肿瘤沉积. 
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表 2 MSCT表现、CT参数与TD之间关系分析
Table 2. The relationship between MSCT findings, CT parameters and TD
指标 β SE Wald χ2 OR 95% CI P 病灶密度 1.399 0.917 2.329 4.053 0.672~24.452 0.127 边界 1.327 0.912 2.114 3.768 0.63~22.532 0.146 形状 1.075 0.846 1.613 2.929 0.558~15.38 0.204 长短径之比 -6.001 1.965 9.322 0.002 0~0.117 0.002 平扫CT值 -0.315 0.093 11.332 0.73 0.608~0.877 0.001 动脉期强化CT值 -0.333 0.094 12.647 0.717 0.597~0.861 < 0.001 AUC: 曲线下面积.
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表 3 MSCT表现、CT参数对于TD诊断价值分析
Table 3. Value of MSCT findings and CT parameters in the diagnosis of TD
指标 AUC 敏感度 特异性 95% CI P 长短径之比 0.836 71.38 82.67 0.764~0.908 < 0.001 平扫CT值 0.832 84.12 39.23 0.760~0.905 < 0.001 动脉期强化CT值 0.878 79.44 82.69 0.816~0.939 < 0.001 模型 0.979 90.48 96.23 0.958~1.00 < 0.001
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