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Added value of spectral parameters in diagnosing metastatic lymph nodes of pT1-2 rectal cancer

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Abstract

Purpose

To investigate the added value of spectral parameters derived from dual-layer spectral detector CT (SDCT) in diagnosing metastatic lymph nodes (LNs) of pT1-2 (stage 1–2 determined by pathology) rectal cancer.

Methods

A total of 80 LNs (57 non-metastatic LNs and 23 metastatic LNs) from 42 patients with pT1-T2 rectal cancer were retrospectively analyzed. The short-axis diameter of LNs was measured, then its border and enhancement homogeneity were evaluated. All spectral parameters, including iodine concentration (IC), effective atomic number (Zeff), normalized IC (nIC), normalized Zeff (nZeff), and slope of the attenuation curve (λ), were measured or calculated. The chi-square test, Fisher’s exact test, independent-samples t-test, or Mann–Whitney U test was used to compare the differences of each parameter between the non-metastatic group and the metastatic group. Multivariable logistic regression analyses were used to determine the independent factors for predicting LN metastasis. Diagnostic performances were assessed by ROC curve analysis and compared with the DeLong test.

Results

The short-axis diameter, border, enhancement homogeneity, and each spectral parameter of LNs showed significant differences between the two groups (P < 0.05). The nZeff and short-axis diameter were independent predictors of metastatic LNs (P < 0.05), with areas under the curve (AUC) of 0.870 and 0.772, sensitivity of 82.5% and 73.9%, and specificity of 82.6% and 78.9%. After combining nZeff and the short-axis diameter, the AUC (0.966) was the highest with sensitivity of 100% and specificity of 87.7%.

Conclusion

The spectral parameters derived from SDCT might help us to improve the diagnostic accuracy of metastatic LNs in patients with pT1-2 rectal cancer, the highest diagnostic performance can be achieved after combining nZeff with the short-axis diameter of LNs.

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Abbreviations

LNM:

Lymph node metastasis

LNs:

Lymph nodes

MRF:

Mesorectal fascia

NCCN:

National comprehensive cancer network

TME:

Total mesorectal excision

DECT:

Dual-energy CT

SDCT:

Spectral detector CT

LNs:

Lymph nodes

ROI:

Region of interest

SBI:

Spectral base image

IC:

Iodine concentration

Zeff :

Effective atomic number

nIC:

Normalized iodine concentration

nZeff :

Normalized effective atomic number

λ:

Slope of the attenuation curve

ROC:

Receiver operating characteristic

AUC:

Area under the curve

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Funding

This work was supported by the Startup Fund for scientific research, Fujian Medical University (Grant number: 2020QH1333).

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Author notes

  1. Jinkai Liu and Hao Pan contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, No. 105, North 91 Road, Xinluo District, Longyan, 364000, Fujian, People’s Republic of China

    Jinkai Liu, Qi Lin, Zhenhuan Huang, Xionghua Huang & Langlang Tang

  2. Department of Radiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China

    Hao Pan

  3. Clinical Science, Philips Healthcare, Shanghai, People’s Republic of China

    Xingbiao Chen

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  1. Jinkai Liu
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Liu, J., Pan, H., Lin, Q. et al. Added value of spectral parameters in diagnosing metastatic lymph nodes of pT1-2 rectal cancer. Abdom Radiol 48, 1260–1267 (2023). https://doi.org/10.1007/s00261-023-03854-9

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