能谱CT在预测结直肠癌术后肝转移中的应用价值

Application value of spectral CT in predicting postoperative liver metastasis in colorectal cancer

摘要

目的：探究能谱CT参数在预测结直肠癌肝转移（CRLM）中的应用价值。方法：选取2020年3月—2023年3月收治的129例结直肠癌患者进行前瞻性研究，所有患者入组时均进行能谱CT扫描，均随访2年，根据2年内是否发生肝转移分为CRLM组（23例）和未发生CRLM组（106例）。收集所有患者的临床资料，Logistic回归分析明确影响CRLM的因素，采用受试者工作特征（ROC）曲线分析能谱CT参数对CRLM发生的预测价值，并进行交叉验证。结果：CRLM组动脉期标准化碘基值（nIC）、静脉期nIC及动脉期CT值均高于未发生CRLM组（P<0.05）；Logistic回归分析显示，Ⅲ期、动脉期CT值及静脉期nIC高水平是CRLM发生的危险因素（P<0.05）；ROC曲线分析结果显示，动脉期CT值、静脉期nIC联合预测CRLM发生的AUC为0.913，高于单独预测的0.669、0.783，两者联合预测效能高于单独预测（Z=3.390、2.010，P<0.05）。交叉验证结果显示，交叉验证预测CRLM发生的AUC为0.906，敏感度、特异度分别为92.14%、83.54%。结论：能谱CT参数中动脉期CT值、静脉期nIC对于预测CRLM发生均有一定的参考价值，两者联合对于预测CRLM的发生具有更高的价值。

Abstract

Objective: To explore the application value of CT parameters in predicting liver metastasis (CRLM) of colorectal cancer. Methods: A total of 129 colorectal cancer patients from March 2020 to March 2023 were selected for prospective study. All patients underwent energy spectrum CT scan at enrollment, followed up for 2 years, and were divided into CRLM group (23 cases) and CRLM group (106 cases) according to whether liver metastases occurred within two years. Clinical data were collected in both groups of patients, and logistic regression analysis identified the factors affecting CRLM. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of spectral CT parameters on the occurrence of CRLM, and cross-validation was carried out. Results: The standardized iodine value (nIC), venous phase nIC and arterial phase CT values in the CRLM group were higher than those in the non-CRLM group (P&lt;0.05). Logistic regression analysis showed that CT values in stage Ⅲ, arterial phase and high levels of nIC in venous phase were risk factors for the occurrence of CRLM (P&lt;0.05). The results of ROC analysis showed that the AUC of CT in arterial phase and nIC in venous phase was 0.913, which was higher than that of 0.669 and 0.783 alone. The combined prediction performance of the two predictions was higher than that of the individual predictions (Z=3.390, 2.010, P&lt;0.05). The cross-validation results showed that the AUC for predicting the occurrence of CRLM was 0.906, and the sensitivity and specificity were 92.14% and 83.54%, respectively. Conclusion: The arterial phase CT value and venous phase nIC in the spectral CT parameters have certain reference value for predicting the occurrence of CRLM, and the combination of the two has higher value in predicting the occurrence of CRLM.

关键词

结直肠癌 / 肝转移 / 能谱CT / 标准化碘基值

Key words

Colorectal cancer•Liver metastasis•Energy spectrum CT•Standardized iodine group values

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