Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2511-2520
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2511
Energy spectrum computed tomography multi-parameter imaging in preoperative assessment of vascular and neuroinvasive status in gastric cancer
Jing Wang, Jian-Cheng Liang, Fa-Te Lin, Jun Ma
Jing Wang, Jian-Cheng Liang, Jun Ma, Department of Radiology, Pingluo County People's Hospital, Shizuishan 753400, Ningxia Hui Autonomous Region, China
Fa-Te Lin, Department of Gastrointestinal Surgery, Jiangsu Provincial People's Hospital, Nanjing 210029, Jiangsu Province, China
Co-first authors: Jing Wang and Jian-Cheng Liang.
Author contributions: Wang J wrote the manuscript; Liang JC and Lin FT collected the data; and Ma J guided the study. All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work. Wang J and Liang JC contributed equally to this work as co-first authors.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Jiangsu Provincial People's Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Subject to patient privacy and data security, research data may be made available to qualified researchers upon reasonable request for scientific research and academic exchange. E-mail: majun63211@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Ma, Doctor, Department of Radiology, Pingluo County People's Hospital, No. 2 Tuanjie West Road, Shizuishan 753400, Ningxia Hui Autonomous Region, China. majun63211@163.com
Received: February 22, 2024
Revised: June 25, 2024
Accepted: July 2, 2024
Published online: August 27, 2024
Processing time: 176 Days and 7.6 Hours
Abstract
BACKGROUND

Vascular and nerve infiltration are important indicators for the progression and prognosis of gastric cancer (GC), but traditional imaging methods have some limitations in preoperative evaluation. In recent years, energy spectrum computed tomography (CT) multiparameter imaging technology has been gradually applied in clinical practice because of its advantages in tissue contrast and lesion detail display.

AIM

To explore and analyze the value of multiparameter energy spectrum CT imaging in the preoperative assessment of vascular invasion (LVI) and nerve invasion (PNI) in GC patients.

METHODS

Data from 62 patients with GC confirmed by pathology and accompanied by energy spectrum CT scanning at our hospital between September 2022 and September 2023, including 46 males and 16 females aged 36-71 (57.5 ± 9.1) years, were retrospectively collected. The patients were divided into a positive group (42 patients) and a negative group (20 patients) according to the presence of LVI/PNI. The CT values (CT40 keV, CT70 keV), iodine concentration (IC), and normalized IC (NIC) of lesions in the upper energy spectrum CT images of the arterial phase, venous phase, and delayed phase 40 and 70 keV were measured, and the slopes of the energy spectrum curves [K (40-70)] from 40 to 70 keV were calculated. Arterial phase combined parameter, venous phase combined parameters (VP-ALLs), and delayed phase association parameters were calculated for patients with late-stage disease. The differences in the energy spectrum parameters between the positive and negative groups were compared, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated to measure the diagnostic efficiency of each parameter.

RESULTS

In the delayed phase, the CT40 keV, CT70 keV, K (40-70), IC, NIC, and CT70 keV and the NIC in the upper arterial and venous phases of energy spectrum CT were greater in the LVI/PNI-positive group than in the LVI-negative group. The representative parameters for the arterial phase NIC were 0.14 ± 0.04 in the positive group and 0.12 ± 0.04 in the negative group. The venous phase NIC was 0.5 (0.5, 0.6) in the positive group and 0.4 (0.4, 0.5) in the negative group. Last, for the delayed phase NIC, it was 0.6 ± 0.1 in the positive group and 0.5 ± 0.1 in the negative group (all P values are less than 0.05). ROC curve analysis demonstrated that the diagnostic efficacy of each parameter during the venous stage was superior to that during the arterial and delayed stages. Furthermore, the diagnostic efficacy of the combined parameter throughout all three stages was superior to that of any single parameter. The AUC, sensitivity, and specificity of the optimal parameter, VP-ALL, were 0.931 (95% confidence interval: 0.872-0.990), 80.95%, and 95.00%, respectively.

CONCLUSION

When assessing the condition of LVI and PNI (perineural invasion) in patients with GC prior to surgery, the ability to diagnose these conditions using venous stage parameters was superior to that using arterial stage and delayed stage parameters. Furthermore, the diagnostic accuracy of using a combination of parameters was better than that of using individual parameters alone.

Keywords: Tomography; X-ray computer; Energy spectrum computed tomography; Gastric cancer; Vascular invasion; Nerve invasion; Cross-sectional study

Core Tip: To investigate the application value of multiparameter energy spectrum computed tomography (CT) imaging in the preoperative assessment of vascular and nerve infiltration in patients with gastric cancer (GC). The imaging data of GC patients were retrospectively analyzed to evaluate the accuracy and sensitivity of CT for identifying and quantifying vascular and nerve infiltration and for comparison with postoperative pathological results. The purpose of this study was to verify the clinical feasibility and potential advantages of multiparameter energy spectrum CT imaging in guiding preoperative diagnosis and treatment decision-making and to provide a new imaging basis for improving the diagnostic accuracy and prognosis of GC patients.