国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (8): 480-484.doi: 10.3760/cma.j.issn.1673-422X.2019.08.007

• 论著 • 上一篇    下一篇

CT灌注扫描定量分析对直肠癌患者放化疗后肿瘤消退分级的预测价值

宋哲1    李伟1    贾楠1    何翔2    周文勇1   

  1. 1河北省沧州市中心医院普外二科    061000；2河北省沧州市中心医院CT诊断科    061000
  • 收稿日期:2019-04-10 修回日期:2019-05-02 出版日期:2019-08-08 发布日期:2019-10-31
  • 通讯作者: 宋哲 E-mail:13393275496@163.com
  • 基金资助:

    沧州市重点研发计划指导项目（183302033）

Value of perfusion CT quantitative analysis for predicting tumor regression grade after chemoradiotherapy in patients with rectal cancer

Song Zhe1, Li Wei1, Jia Nan1, He Xiang2, Zhou Wenyong1   

  1. 1Second Department of General Surgery, Cangzhou Central Hospital of Hebei Province, Cangzhou 061000, China; 2Department of Diagnostic CT, Cangzhou Central Hospital of Hebei Province, Cangzhou 061000, China
  • Received:2019-04-10 Revised:2019-05-02 Online:2019-08-08 Published:2019-10-31
  • Contact: Song Zhe E-mail:13393275496@163.com
  • Supported by:

    Cangzhou Key Research and Development Program Guide Project (183302033)

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摘要： 目的    探究CT灌注扫描定量分析对直肠癌患者放化疗后肿瘤消退分级（TRG）的预测价值。方法    选取河北省沧州市中心医院2016年6月至2018年6月间诊断及治疗的直肠癌患者94例，根据手术标本结果分为反应组（TRG3~4级）及无反应组（TRG 0~2级）。所有患者治疗前均行CT灌注扫描，治疗采用放化疗及手术，比较两组患者的CT灌注扫描参数包括血流量、血容量、平均通过时间（MTT）、表面通透性（PS），应用受试者工作特征曲线评估CT灌注扫描参数对直肠癌患者放化疗反应性的预测效能。结果    本研究共有23例（24.47%）直肠癌患者对放化疗有反应，71例（75.53%）患者对放化疗无反应。反应组的血流量为(38.60±7.13)ml·100 g-1·min-1，显著小于无反应组的（67.39±11.33）ml·100 g-1·min-1，差异有统计学意义（t=3.273，P=0.001）；反应组的MTT为（11.12±2.19）s，显著长于无反应组的（6.88±1.32）s，差异有统计学意义（t=4.500，P＜0.001）；反应组的血容量和PS分别为（4.62±0.73）ml/100 g、（13.72±3.82）ml·100 g-1·min-1，与无反应组的（5.01±1.04）ml/100 g、（11.40±2.59）ml·100 g-1·min-1差异均无统计学意义（t=0.818，P=0.415；t=0.409，P=0.683）。血流量及MTT预测放化疗反应性的最佳临界值分别为50.89 ml·100 g-1·min-1及8.99 s，曲线下面积（AUC）分别为0.825及0.922，二者联合预测放化疗反应性的AUC为0.982，显著优于单项预测（Z=2.868，P=0.004；Z=2.051，P=0.004）；二者联合预测的准确率（91.49%）、特异性（90.14%）显著优于单项预测（血流量：准确率75.53%，特异性73.24%；MTT： 准确率79.79%，特异性78.87%），差异有统计学意义（χ2=8.800，P=0.012；χ2=6.766，P=0.034）。结论    CT灌注扫描参数血流量联合MTT对直肠癌患者放化疗反应性具有较好的预测价值。

关键词: 体层摄影术, 直肠肿瘤, 肿瘤分级, 疗效评估

Abstract: Objective  To explore the value of perfusion CT quantitative analysis for predicting tumor regression grade (TRG) after chemoradiotherapy in patients with rectal cancer. Methods  From June 2016 to June 2018, 94 rectal cancer patients diagnosed and treated in Cangzhou Central Hospital of Hebei Province were selected and were divided into reaction group (TRG 3-4) and nonreaction group (TRG 0-2) according to the results of surgical specimens. Perfusion CT was performed in both groups before treatment, and chemoradiotherapy and surgery were used. Baseline data and perfusion CT results including blood flow, blood volume, mean transit time (MTT), permeability surface (PS) were compared between the two groups, and receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of perfusion CT indexes for chemoradiotherapy responsiveness. Results  In this study, a total of 23 cases (24.47%) were responsive to chemoradiotherapy, and 71 cases (75.53%) were not responsive to chemoradiotherapy. Blood flow in reaction group ［(38.60±7.13) ml·100 g-1·min-1］ was significantly lower than that in non-reaction group ［(67.39±11.33) ml·100 g-1·min-1, t=3.273, P=0.001］. MTT in reaction group was significantly longer than that in non-reaction group ［(11.12±2.19) s vs. (6.88±1.32) s, t=4.500, P＜0.001］. There was no significant difference in blood volume ［(4.62±0.73) ml/100 g vs. (5.01±1.04) ml/100 g］ and PS ［(13.72±3.82) ml·100 g-1·min-1 vs. (11.40±2.59) ml·100 g-1·min-1］ between the two groups (t=0.818, P=0.415; t=0.409, P=0.683). The best cut-off points of blood flow and MTT for predicting chemoradiotherapy responsiveness were 50.89 ml·100 g-1·min-1 and 8.99 s, the area under the curve (AUC) was 0.825 and 0.922, and the AUC of combined prediction of chemoradiotherapy responsiveness was 0.982, which was significantly better than that of single prediction (Z=2.868, P=0.004; Z=2.051, P=0.004). The accuracy (91.49%) and specificity (90.14%) of combined prediction of chemoradiotherapy responsiveness were significantly better than those of single prediction (blood flow: accuracy 75.53%, specificity 73.24%; MTT: accuracy 79.79%, specificity 78.87%), and the differences were statistically significant (χ2=8.800, P=0.012; χ2=6.766, P=0.034). Conclusion  Blood flow and MTT in perfusion CT have great predictive value for chemoradiotherapy responsiveness in patients with rectal cancer.

Key words: Tomography, Rectal neoplasms, Neoplasm grading, Efficacy evaluation