能谱CT术前诊断胃腺癌周围神经侵犯

目的 观察能谱CT术前诊断胃腺癌周围神经侵犯（PNI）的价值。方法 对270例拟行手术治疗的胃腺癌患者于术前1周内行能谱CT扫描，测量增强动脉期、静脉期和延迟期病灶碘浓度（IC）和标准化IC （nIC）；据术后病理报告将患者分为PNI组和无PNI组，对比组间病灶IC和nIC差异，以多因素logistic回归分析筛选PNI独立危险因素，采用受试者工作特征（ROC）曲线评估IC参数诊断PNI的效能。结果 270例中，术后病理证实123例PNI （PNI组）、147例无PNI （无PNI组）；组间肿瘤厚度、Borrmann分型、（术前）临床T分期（cT）、CT报告淋巴结状态、病理T分期（pT）及病理N分期（pN）差异均有统计学意义（P均<0.05）。PNI组病灶静脉期IC （ICVP）、延迟期IC （ICDP）及静脉期nIC （nICVP）、延迟期nIC （nICDP）均高于无PNI组（P均<0.001）。logistic回归分析显示，cT分期和nICDP是PNI的独立危险因素；ROC曲线示cT分期联合nICDP诊断PNI的曲线下面积（0.832）高于单一cT分期及IC参数（P均<0.05）。结论 能谱CT可于术前诊断胃腺癌PNI；联合cT分期可提前诊断效能。

Spectral CT for preoperative diagnosis of perineural invasion of gastric adenocarcinoma

Objective To observe the value of spectral CT for preoperative diagnosis of perineural invasion (PNI) of gastric adenocarcinoma. Methods Totally 270 patients with gastric adenocarcinoma who scheduled to underwent gastrectomy were prospectively scanned on spectral CT platform with triple phased (arterial, venous, delay) contrasted enhanced CT within 1 week before surgery. The iodine concentration (IC) and normalized IC (nIC) of gastric cancers of each phase were measured. According to postoperative pathological reports, the patients were divided into PNI group and non-PNI group. Differences of IC and nIC values between the 2 groups were compared. Multivariable logistic regression analysis was used to screen independent risk factors of PNI. Receiver operating characteristic (ROC) curve was performed to estimate the diagnostic efficacy. Results Among 270 cases of gastric adenocarcinoma, 123 cases were found with PNI (PNI group) and 147 cases without PNI (no PNI group). There were significant differences of tumor thicknesses, Borrmann classifications, preoperatively clinical T stage (cT), CT reporting lymph node status, pathological T stage (pT) and pathological N stage (pN) between groups (all P<0.05). IC at venous phase (ICVP)and delay phase (ICDP), as well as nICVP and nICDP in PNI group were higher than those in non-PNI group (all P<0.001). Logistic regression analysis revealed that cT and nICDP were independent risk factors of PNI. ROC curve showed that the area under the curve (AUC) of cT stage combined with nICDP (0.832) for diagnosing PNI was higher than that of single cT stage and IC parameters (all P<0.05). Conclusion Spectral CT could preoperatively diagnose PNI of gastric adenocarcinoma. Combination of cT staging could advance the diagnostic efficacy of Spectral CT.