双能量CT多定量参数可评估卵巢高级别浆液性癌肿瘤细胞的增殖活性

目的  探讨双能量CT多定量参数无创评估卵巢高级别浆液性癌肿瘤细胞增殖能力的价值。 方法  回顾性收集2021年6月~2023年1月盐城市第一人民医院66例经手术证实的连续性卵巢高级别浆液性癌病例，所有患者术前2周内均行能谱CT平扫及增强扫描，术后所有肿瘤组织病理标本切片行Ki-67免疫组织化学染色，根据术后病理分为Ki-67高表达组（n=34）及Ki-67低表达组（n=32）；由2位观察者分别独立测量病灶动脉期及静脉期40~90 keV单能量CT值、碘浓度，计算标准化碘浓度及能谱曲线斜率（K_{40-90 keV}）；采用组内相关系数检验2位测量者测量参数之间相关性及一致性的程度；比较两组之间各参数的差异，对差异有统计学意义的参数采用ROC曲线分析诊断效能，并分析差异有统计学意义的参数与Ki-67表达的相关性。 结果  2位测量者对动脉期、静脉期两组间测得的各参数一致性较好，组内相关系数均大于0.75；低表达组动脉期、静脉期40~70 keV单能量CT值、K_{40-90 keV}、碘浓度、标准化碘浓度均低于Ki-67高表达组（P < 0.05），ROC曲线分析显示动脉期K_{40-90 keV}诊断效能最高，曲线下面积为0.913，敏感度为91.2%，特异性为87.5%，阈值为0.95，上述参数与Ki-67表达均有相关性，以动脉期K_{40-90 keV}与其的相关系数最高（rs=-0.900，P < 0.001）。 结论  双能量CT多定量参数可无创评估卵巢高级别浆液性癌肿瘤细胞的增殖能力。

Dual-energy CT multiple quantitative parameters can evaluate the proliferative activity of high-grade serous ovarian carcinoma

Objective To explore the value of non-invasive assessment for the proliferative ability of ovarian high-grade serous carcinoma tumor cells using dual-energy CT multiple quantitative parameters. Methods We retrospectively analyzed 66 cases of high-grade serous ovarian carcinoma confirmed by surgery at the First People's Hospital of Yancheng City from June 2021 to January 2023. All patients underwent spectral CT plain and enhanced scans within 2 weeks prior to surgery. After surgery, all tumor tissue pathological specimens were stained with Ki-67 immunohistochemistry. According to postoperative pathological findings, patients were classified into Ki-67 high expression group (n=34) and Ki-67 low expression group (n=32). The measurement of arterial and venous phase single-energy CT values (40-90 keV) and iodine concentration of the lesions were independently conducted by two observers. Normalized iodine concentration and energy spectrum curve slope (K40-90 keV) were calculated. Intra-group correlation coefficient was used to evaluate the consistency and correlation between the measurement parameters of the two observers. The differences in various parameters between the two groups were compared. ROC curves were calculated to evaluate the diagnostic efficacy of the related parameters with statistically significant differences. The correlation between the parameters with statistically significant differences and Ki-67 expression was analyzed. Results Two observers showed good consistency in the measurement of various parameters in the arterial and venous phases, with all the intra-group correlation coefficient was greater than 0.75. The low expression group had lower arterial and venous phase 40-70 keV single-energy CT values, iodine concentration, normalized iodine concentration and K40-90 keV than the high expression group (P < 0.05). ROC curve analysis showed that the diagnostic efficacy of arterial phase K40-90 keV was the highest, with an AUC of 0.913, sensitivity of 91.2%, specificity of 87.5%, and a threshold of 0.95. The above parameters were also correlated with Ki-67 expression, with the highest correlation coefficient observed between arterial phase K40-90keV and Ki-67 (rs=-0.900, P < 0.001). Conclusion Dual-energy CT can non-invasively evaluate the proliferative ability of high-grade serous ovarian carcinoma cells using multiple quantitative parameters.