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Abstract：
OBJECTIVE: Evaluation of the predictive value of one-stop energy spectrum and perfusion CT parameters for microvessel density (MVD) in colorectal cancer cancer foci.
METHODS: Clinical and CT data of 82 patients with colorectal cancer confirmed by preoperative colonoscopy or surgical pathology in our hospital from September 2019 to November 2022 were collected and analyzed retrospectively. Energy spectrum CT images were measured using the Protocols general module of the GSI Viewer software of the GE AW 4.7 post-processing workstation to measure the CT values of the arterial and venous phase lesions and the neighboring normal intestinal wall in a single energy range of 40 kev∼140 kev, and the slopes of the energy spectrum curves (λ) were calculated between 40 kev-90 kev; Iodine concentration (IC), Water concentration (WC), Effective-Z (Eff-Z) and Normalized iodine concentration (NIC) were measured by placing a region of interest (ROI) on the iodine concentration map and water concentration map at the lesion and adjacent to the normal intestinal wall.Perfusion CT images were scanned continuously and dynamically using GSI Perfusion software and analyzed by applying CT Perfusion 4.0 software.Blood volume (BV), blood flow (BF), surface permeability (PS), time to peak (TTP), and mean transit time (MTT) were measured respectively in the lesion and adjacent normal colorectal wall. Based on the pathological findings, the tumors were divided into a low MVD group (MVD < 35/field of view, n = 52 cases) and a high MVD group (MVD ≥ 35/field of view, n = 30 cases) using a median of 35/field of view as the MVD grouping criterion. The collected data were statistically analyzed, the subjects\' operating characteristic curve (ROC) was plotted, and the area under curve (AUC), sensitivity, specificity, and Yoden index were calculated for the predicted efficacy of each parameter of the energy spectrum and perfusion CT and the combined parameters.
RESULTS: The CT values, IC, NIC, λ, Eff-Z of 40kev∼140kev single energy in the arterial and venous phase of colorectal cancer in the high MVD group were higher than those in the low MVD group, and the differences were all statistically significant (p < 0.05). The AUC of each single-energy CT value in the arterial phase from 40 kev to 120 kev for determining the high or low MVD of colorectal cancer was greater than 0.8, indicating that arterial stage has a good predictive value for high or low MVD in colorectal cancer; AUC for arterial IC, NIC and IC + NIC were all greater than 0.9, indicating that in arterial colorectal cancer, both single and combined parameters of spectral CT are highly effective in predicting the level of MVD. The AUC of 40 kev to 90 kev single-energy CT values in the intravenous phase was greater than 0.9, and its diagnostic efficacy was more representative; The AUC of IC and NIC in venous stage were greater than 0.8, which indicating that the IC and NIC energy spectrum parameters in venous stage colorectal cancer have a very good predictive value for the difference between high and low MVDs, with the greatest diagnostic efficacy in IC.The values of BV and BF in the high MVD group were higher than those in the low MVD group, and the differences were statistically significant (P < 0.05), and the AUC of BF, BV, and BV + BF were 0.991, 0.733, and 0.997, respectively, with the highest diagnostic efficacy for determining the level of MVD in colorectal cancer by BV + BF.
CONCLUSIONS: One-stop CT energy spectrum and perfusion imaging technology can accurately reflect the MVD in living tumor tissues, which in turn reflects the tumor angiogenesis, and to a certain extent helps to determine the malignancy, invasion and metastasis of living colorectal cancer tumor tissues based on CT energy spectrum and perfusion parameters.
METHODS: Clinical and CT data of 82 patients with colorectal cancer confirmed by preoperative colonoscopy or surgical pathology in our hospital from September 2019 to November 2022 were collected and analyzed retrospectively. Energy spectrum CT images were measured using the Protocols general module of the GSI Viewer software of the GE AW 4.7 post-processing workstation to measure the CT values of the arterial and venous phase lesions and the neighboring normal intestinal wall in a single energy range of 40 kev∼140 kev, and the slopes of the energy spectrum curves (λ) were calculated between 40 kev-90 kev; Iodine concentration (IC), Water concentration (WC), Effective-Z (Eff-Z) and Normalized iodine concentration (NIC) were measured by placing a region of interest (ROI) on the iodine concentration map and water concentration map at the lesion and adjacent to the normal intestinal wall.Perfusion CT images were scanned continuously and dynamically using GSI Perfusion software and analyzed by applying CT Perfusion 4.0 software.Blood volume (BV), blood flow (BF), surface permeability (PS), time to peak (TTP), and mean transit time (MTT) were measured respectively in the lesion and adjacent normal colorectal wall. Based on the pathological findings, the tumors were divided into a low MVD group (MVD < 35/field of view, n = 52 cases) and a high MVD group (MVD ≥ 35/field of view, n = 30 cases) using a median of 35/field of view as the MVD grouping criterion. The collected data were statistically analyzed, the subjects\' operating characteristic curve (ROC) was plotted, and the area under curve (AUC), sensitivity, specificity, and Yoden index were calculated for the predicted efficacy of each parameter of the energy spectrum and perfusion CT and the combined parameters.
RESULTS: The CT values, IC, NIC, λ, Eff-Z of 40kev∼140kev single energy in the arterial and venous phase of colorectal cancer in the high MVD group were higher than those in the low MVD group, and the differences were all statistically significant (p < 0.05). The AUC of each single-energy CT value in the arterial phase from 40 kev to 120 kev for determining the high or low MVD of colorectal cancer was greater than 0.8, indicating that arterial stage has a good predictive value for high or low MVD in colorectal cancer; AUC for arterial IC, NIC and IC + NIC were all greater than 0.9, indicating that in arterial colorectal cancer, both single and combined parameters of spectral CT are highly effective in predicting the level of MVD. The AUC of 40 kev to 90 kev single-energy CT values in the intravenous phase was greater than 0.9, and its diagnostic efficacy was more representative; The AUC of IC and NIC in venous stage were greater than 0.8, which indicating that the IC and NIC energy spectrum parameters in venous stage colorectal cancer have a very good predictive value for the difference between high and low MVDs, with the greatest diagnostic efficacy in IC.The values of BV and BF in the high MVD group were higher than those in the low MVD group, and the differences were statistically significant (P < 0.05), and the AUC of BF, BV, and BV + BF were 0.991, 0.733, and 0.997, respectively, with the highest diagnostic efficacy for determining the level of MVD in colorectal cancer by BV + BF.
CONCLUSIONS: One-stop CT energy spectrum and perfusion imaging technology can accurately reflect the MVD in living tumor tissues, which in turn reflects the tumor angiogenesis, and to a certain extent helps to determine the malignancy, invasion and metastasis of living colorectal cancer tumor tissues based on CT energy spectrum and perfusion parameters.
摘要：
目的：评估一站式能谱和灌注CT参数对结直肠癌癌灶中微血管密度（MVD）的预测价值。
方法：回顾性分析2019年9月至2022年11月我院经术前结肠镜或手术病理证实的82例结直肠癌患者的临床及CT资料。利用GEAW4.7后处理工作站的GSIViewer软件的Protocols通用模块测量能谱CT图像,在40kev～140kev的单一能量范围内测量动静脉期病变及邻近正常肠壁的CT值,并计算了40kev-90kev之间的能谱曲线斜率（λ）；碘浓度（IC），水浓度(WC),通过在病变处和邻近正常肠壁的碘浓度图和水浓度图上放置感兴趣区域(ROI)来测量有效-Z(Eff-Z)和归一化碘浓度(NIC)。使用GSI灌注软件连续动态扫描灌注CT图像，并应用CT灌注4.0软件进行分析。血容量（BV），血流量（BF），表面渗透率（PS），达到峰值的时间(TTP)分别测量病变和邻近正常结直肠壁的平均通过时间（MTT）。根据病理结果,将肿瘤分为低MVD组(MVD<35/视场，n=52例）和高MVD组（MVD≥35/视野，n=30例），使用中位数为35/视场作为MVD分组标准。对收集的数据进行统计分析,绘制受试者的工作特征曲线(ROC)，和曲线下面积（AUC），灵敏度,特异性，和Yoden指数分别计算了能谱和灌注CT各参数及组合参数的预测效能。
结果：CT值，IC,NIC,λ,高MVD组结直肠癌动脉期和静脉期的40kev~140kev单能量的Eff-Z高于低MVD组,差异均有统计学意义(p<0.05)。动脉期40kev~120kev各单能量CT值的AUC均大于0.8,说明动脉期对于结直肠癌的高或低MVD有较好的预测价值;AUC对于动脉IC、NIC和IC+NIC均大于0.9，表明在动脉结直肠癌中，能谱CT的单一参数和组合参数在预测MVD水平方面都非常有效。静脉期40kev～90kev单能量CT值的AUC大于0.9,其诊断效能更具代表性;静脉期IC和NIC的AUC大于0.8,说明静脉期结直肠癌的IC和NIC能谱参数对高、低MVD的差异有很好的预测价值,在IC中具有最大的诊断功效。高MVD组的BV和BF值均高于低MVD组,差异有统计学意义(P<0.05),和BF的AUC，BV,和BV+BF分别为0.991、0.733和0.997，用BV+BF测定结直肠癌MVD水平的诊断效能最高。
结论：一站式CT能谱和灌注成像技术可以准确反映活体肿瘤组织的MVD，这反过来又反映了肿瘤的血管生成，在某种程度上有助于确定恶性肿瘤，基于CT能谱和灌注参数的活体结直肠癌肿瘤组织浸润转移研究.
方法：回顾性分析2019年9月至2022年11月我院经术前结肠镜或手术病理证实的82例结直肠癌患者的临床及CT资料。利用GEAW4.7后处理工作站的GSIViewer软件的Protocols通用模块测量能谱CT图像,在40kev～140kev的单一能量范围内测量动静脉期病变及邻近正常肠壁的CT值,并计算了40kev-90kev之间的能谱曲线斜率（λ）；碘浓度（IC），水浓度(WC),通过在病变处和邻近正常肠壁的碘浓度图和水浓度图上放置感兴趣区域(ROI)来测量有效-Z(Eff-Z)和归一化碘浓度(NIC)。使用GSI灌注软件连续动态扫描灌注CT图像，并应用CT灌注4.0软件进行分析。血容量（BV），血流量（BF），表面渗透率（PS），达到峰值的时间(TTP)分别测量病变和邻近正常结直肠壁的平均通过时间（MTT）。根据病理结果,将肿瘤分为低MVD组(MVD<35/视场，n=52例）和高MVD组（MVD≥35/视野，n=30例），使用中位数为35/视场作为MVD分组标准。对收集的数据进行统计分析,绘制受试者的工作特征曲线(ROC)，和曲线下面积（AUC），灵敏度,特异性，和Yoden指数分别计算了能谱和灌注CT各参数及组合参数的预测效能。
结果：CT值，IC,NIC,λ,高MVD组结直肠癌动脉期和静脉期的40kev~140kev单能量的Eff-Z高于低MVD组,差异均有统计学意义(p<0.05)。动脉期40kev~120kev各单能量CT值的AUC均大于0.8,说明动脉期对于结直肠癌的高或低MVD有较好的预测价值;AUC对于动脉IC、NIC和IC+NIC均大于0.9，表明在动脉结直肠癌中，能谱CT的单一参数和组合参数在预测MVD水平方面都非常有效。静脉期40kev～90kev单能量CT值的AUC大于0.9,其诊断效能更具代表性;静脉期IC和NIC的AUC大于0.8,说明静脉期结直肠癌的IC和NIC能谱参数对高、低MVD的差异有很好的预测价值,在IC中具有最大的诊断功效。高MVD组的BV和BF值均高于低MVD组,差异有统计学意义(P<0.05),和BF的AUC，BV,和BV+BF分别为0.991、0.733和0.997，用BV+BF测定结直肠癌MVD水平的诊断效能最高。
结论：一站式CT能谱和灌注成像技术可以准确反映活体肿瘤组织的MVD，这反过来又反映了肿瘤的血管生成，在某种程度上有助于确定恶性肿瘤，基于CT能谱和灌注参数的活体结直肠癌肿瘤组织浸润转移研究.
