双能CT细胞外容积分数在鉴别胰腺导管内乳头状黏液性肿瘤良恶性中的应用价值
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南京医科大学第一附属医院放射科

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分子靶向CT成像评价胰腺癌乏氧水平与TH-302疗效相关性的实验研究


The value of the extracellular volume fraction measured by dual-energy computed tomography in differentiating benign and malignant intraductal papillary mucinous neoplasms
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Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province

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The Experimental Study of Molecular Targeted CT Imaging in Evaluating the Correlation between Hypoxia Level and TH-302 Efficacy in pancreatic cancer

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    摘要:

    摘要: 目的:探讨双能CT(Dual-energy computed tomography,DECT)细胞外容积分数(Extracellular volume fraction,ECV)在鉴别胰腺导管内乳头状黏液性肿瘤(Intraductal papillary mucinous neoplasm,IPMN)良恶性中的应用价值。方法:回顾性搜集2018年6月至2021年12月间外科手术病理证实为IPMN,且术前一月内行DECT检查的患者57例(良性组28例,恶性组29例)。测量平衡期病灶周围1cm范围内的胰腺实质碘浓度(Iodine concentration,IC)及同一层面腹主动脉IC,依据(IC胰腺/IC腹主动脉)x(1-红细胞比容)公式计算DECT-ECV。对两组患者的临床及影像资料进行单因素及多因素Logistic回归分析,确定独立危险因素并分别构建影像模型、临床模型及影像联合临床模型。采用受试者工作特征曲线评估其诊断效能,并使用Delong检验进行比较。结果:多因素Logistic回归分析提示,DECT-ECV、糖类抗原(Carbohydrate antigen,CA)19-9升高、有无急性胰腺炎(Acute pancreatitis,AP)病史是恶性IPMN的独立危险因素。影像模型(DECT-ECV)、临床模型(CA19-9升高及有无AP病史)、影像联合临床模型(DECT-ECV、CA19-9升高及有无AP病史)诊断恶性IPMN的曲线下面积分别为0.808、0.759、0.884。影像联合临床模型的诊断效能显著高于临床模型(P=0.007)。结论:病灶周围胰腺实质的DECT-ECV参数可以提高良恶性IPMN的鉴别诊断效能,为临床诊疗提供参考依据。

    Abstract:

    Abstract: Objective: To explore the value of extracellular volume fraction (ECV) measured by dual-energy computed tomography (DECT) in differentiating benign and malignant intraductal papillary mucinous neoplasms (IPMNs). Methods: A total of 57 patients with IPMN confirmed by surgical pathology and underwent DECT examination within 1 month before the operation were retrospectively collected from June 2018 to December 2021. According to pathological results, the patients were divided into benign group(28 cases) and malignant group(29 cases), and the iodine concentration (IC) of pancreatic parenchyma within 1cm around the lesions and abdominal aorta on the same picture in the delayed-phase were measured respectively and the value of DECT-ECV was calculated according to the formula: (ICpancreas/ICabdominal aorta) x (1-Hematocrit). The clinical and imaging data of the two groups were analyzed by univariate analysis and multivariate Logistic regression analysis to determine the independent risk factors, and the imaging model, clinical model and imaging combined clinical model were constructed respectively. The performance of each model was evaluated according to the area under curve (AUC) under the receiver operating characteristic (ROC). Results: Multivariate analysis showed that the DECT-ECV, the elevated level of carbohydrate antigen (CA) 19-9 , and the history of acute pancreatitis (AP) were independent risk factors for differentiating benign and malignant IPMNs. The AUC of imaging model (DECT-ECV), clinical model (the elevated level of CA19-9 and the history of AP), and imaging combined clinical model (DECT-ECV, the elevated level of CA19-9 and the history of AP) in diagnosing malignant IPMN were 0.808, 0.759, and 0.884, respectively. The diagnostic efficacy of imaging combined clinical model was significantly higher than that of clinical model. Conclusion: DECT-ECV of the pancreas parenchyma around the lesions can differentiate benign and malignant IPMN, and could provide a certain reference for clinical treatment.

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  • 收稿日期:2023-03-02
  • 最后修改日期:2023-05-14
  • 录用日期:2023-08-29
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