进展期胃癌NAC后胃癌周围脂肪组织双能CT碘含量的判断

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摘要目的：探讨双能量CT成像测量胃癌周围脂肪组织碘含量判断胃癌NAC后浆膜状况的价值。方法：分析34例T4进展期胃癌患者NAC前、后双能量图像，根据术后病理分组，比较T降期组（ｎ＝10）与未降期组（ｎ＝24）胃癌周围脂肪组织碘含量（IC胃癌周脂肪）和标准化胃癌周围脂肪组织碘含量（IC标准化胃癌周脂肪），采用ROC曲线法评价其判断NAC后浆膜受侵的能力。结果：与术后病理对照，传统CT判断NAC后浆膜状况的准确性为70.59%。降期组与未降期组NAC前、后IC胃癌周脂肪的变化（△IC胃癌周脂肪）及IC标准化胃癌周脂肪的变化（△IC标准化胃癌周脂肪）的差异有统计学意义（P均＜0.05）。曲线下面积（AUC）为0.908，△IC标准化胃癌周脂肪界值为0.095时，判断NAC后浆膜受侵的敏感性为90.0%，特异性为83.3%，准确性为85.29%。结论：IC标准化胃癌周脂肪是一项可较准确判断NAC后浆膜状况、指导确定手术时机的有效指标。

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	杨丽
	时高峰
	李勇
	周涛

关键词 ：胃肿瘤, 体层摄影术, X线计算机

Abstract：Objective: To explore the value of measuring iodine concentration(IC) in perigastric adipose tissue with dual-energy CT(DECT) for judgment of serosa status after neoadjuvant chemotherapy(NAC). Methods: Thirty-four patients with T4 advanced gastric cancer who underwent DECT before and after treatment were enrolled. According to the postoperative pathologic results, the patients were divided into two groups: the down-staging group(n=10) and the non-down-staging group(n=24). IC(ICPAT) and standardized IC(SICPAT) of perigastric adipose tissue were measured in the two groups, respectively. ROC curve was used to evaluate the capability of SICPAT in detecting serosa invasion. Results: Compared with postoperative pathologic results, the accuracy of judgment of serosa status was 70.59% by conventional CT after NAC. The differences of the changes of ICPAT(△ICPAT) and SICPAT(△SICPAT) between the two groups were statistically significant(P＜0.05). With a △SICPAT threshold of 0.095, area under curve(AUC) was 0.908, the sensitivity, specificity and accuracy for detecting serosa invasion were 90.0%, 83.3% and 85.29%, respectively. Conclusion: The SICPAT in perigastric adipose tissue is an effective indicator to determine the serosa status after NAC and to guide the operation time.

Key words： Stomach neoplasms Tomography, X-ray computed

收稿日期: 2017-05-31

PACS:	Ｒ735.2
	Ｒ814.42

通讯作者: 时高峰，河北医科大学第四医院CT MR科，050011。E-mail：gaofengs62@sina.com

作者简介: 杨丽（1980-），女，河北衡水人，副主任医师。E-mail：13582165802@163.com

引用本文:

杨丽，时高峰，李勇，周涛. 进展期胃癌NAC后胃癌周围脂肪组织双能CT碘含量的判断[J]. 中国临床医学影像杂志, 2018, 29(4): 273-276.
YANG Li, SHI Gao-feng, LI Yong, ZHOU Tao. Measuring iodine concentration in perigastric adipose tissue with DECT for judgment of serosa status in patients with advanced gastric cancer after NAC. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(4): 273-276.

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http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I4/273

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