Dual energy CT is useful for the prediction of mesenteric and lateral pelvic lymph node metastasis in rectal cancer
Dual energy CT is useful for the prediction of mesenteric and lateral pelvic lymph node metastasis in rectal cancer
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DOI：
10.3892/mco.2019.1834
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发表时间：
2019-06-01
影响因子：
1.2
通讯作者：
Hakamada, Kenichi
中科院分区：
文献类型：
--
作者：
Sato, Kentaro;Morohashi, Hajime;Hakamada, Kenichi
本回顾性研究的目的是探讨双能量计算机断层扫描（DECT）对直肠癌（RC）直肠旁淋巴结（PRLN）转移和盆腔外侧淋巴结（LPLN）转移的预测性。本研究涉及44名RC患者，他们在2015年5月至2017年9月期间接受了DECT检查，然后接受了手术。24例患者行LPLN剥离术。计算最大PRLN和LPLN的标准化碘浓度（nIC），即DECT上淋巴结（LN）碘浓度与髂总动脉碘浓度的比值，并分析LN转移与nIC的关系。在动脉期[0.18 vs. 0.25; P=0.01;临界值，0.24;曲线下面积（AUC），0.733]和门静脉期（0.47 vs. 0.61; P=0.03;临界值，0.59; AUC，0.701），PRLN转移阳性病例的PRLN中位nIC值显著低于PRLN转移阴性病例。在PRLN转移阳性和转移阴性病例中，PRLN的中位最大短轴直径之间未发现显著差异（7.6与6.4 mm; P=0.33）。动脉期LPLN转移阳性和转移阴性病例之间LPLN的nIC无显著差异（0.15 vs. 0.21; P=0.19）;但门脉期LPLN转移阳性病例显著低于LPLN转移阴性病例（0.29 vs. 0.56; P=0.04;临界值，0.29; AUC，0.877）。与LPLN转移阴性病例相比，转移阳性病例的LPLN最大短轴直径显著更大（9.1 vs. 4.8 mm; P=0.03;临界值，7.0 mm; AUC，0.912）。总之，nIC被确定为在转移阳性病例中显著较低，这可能有助于预测PRLN和LPLN转移。基于大小的诊断和DECT的组合可以提高术前诊断的准确性。
The aim of the present retrospective study was to investigate the predictability of dual-energy computed tomography (DECT) for pararectal lymph node (PRLN) metastasis and lateral pelvic lymph node (LPLN) metastasis in rectal cancer (RC). The present study involved 44 patients with RC who were examined by DECT and then underwent surgery between May 2015 and September 2017. LPLN dissection was performed in 24 patients. The normalized iodine concentration (nIC), the ratio of iodine concentration in the lymph node (LN) to that in the common iliac artery on DECT, of the largest PRLN and LPLN was calculated, and the association between LN metastasis and nIC was analyzed. The median nIC value for PRLNs was significantly lower in PRLN metastasis-positive cases compared with PRLN metastasis-negative cases in the arterial phase [0.18 vs. 0.25; P=0.01; cut-off, 0.24; area under the curve (AUC), 0.733] and portal phase (0.47 vs. 0.61; P=0.03; cut-off, 0.59; AUC, 0.701). A significant difference was not identified between the median maximum short axis diameter of PRLNs in PRLN metastasis-positive and metastasis-negative cases (7.6 vs. 6.4 mm; P=0.33). The nIC for LPLNs was not significantly different between LPLN metastasis-positive and metastasis-negative cases in the arterial phase (0.15 vs. 0.21; P=0.19); but was significantly lower in LPLN metastasis-positive cases compared with LPLN metastasis-negative cases in the portal phase (0.29 vs. 0.56; P=0.04; cut-off, 0.29; AUC, 0.877). The maximum short axis diameter of LPLNs was significantly larger in metastasis-positive cases compared with LPLN metastasis-negative cases (9.1 vs. 4.8 mm; P=0.03; cut-off, 7.0 mm; AUC, 0.912). In conclusion, the nIC was identified to be significantly lower in metastasis-positive cases, which may be useful for the prediction of PRLN and LPLN metastases. A combination of size-based diagnosis and DECT may increase the accuracy of preoperative diagnosis.