能谱CT在结直肠癌诊疗中的研究进展

Research Progress of Spectral CT in the Diagnosis and Treatment of Colorectal Cancer

摘要: 目的：综述能谱CT在结直肠癌(colorectal cancer, CRC)诊疗中的研究进展，特别是CRC诊断与分期、淋巴结转移(lymph node metastasis, LNM)、分子标志物预测还有治疗反应评估等方面。方法：通过对相关文献的检索，对能谱CT在结直肠癌诊疗中的临床应用价值进行分析与总结。结果：能谱CT通过双能量采集的方式，实现物质分离，从而提供碘浓度(IC)、虚拟单能量图像(VMI)、有效原子序数(Zeff)及能谱曲线斜率(λHU)等多个定量参数。在原发灶检测与T分期方面，可明显提升结直肠癌的诊断效能与T分期的准确性；在淋巴结转移评估方面，碘浓度、Zeff等参数与影像组学模型相联合后的诊断效能远优于传统形态学标准；在分子标志物预测方面，能谱参数与KRAS突变及微卫星不稳定性(MSI)状态具有相关性；在治疗反应评估方面，基线能谱CT参数能在早期预测化疗疗效及患者预后。结论：能谱CT在结直肠癌精准诊疗当中具有重要的临床应用价值。

Abstract: Objective: To review the research progress of spectral CT in the diagnosis and treatment of colorectal cancer (CRC), particularly in terms of CRC diagnosis and staging, lymph node metastasis (LNM), prediction of molecular biomarkers, and assessment of treatment response. Methods: By retrieving relevant literature, the clinical application value of spectral CT in the diagnosis and treatment of colorectal cancer was analyzed and summarized. Results: Spectral CT, through dual‑energy acquisition, enables material decomposition and provides multiple quantitative parameters, including iodine concentration (IC), virtual monoenergetic images (VMI), effective atomic number (Zeff), and spectral curve slope (λHU). In primary tumor detection and T staging, it can significantly improve the diagnostic efficacy and the accuracy of T staging. In the assessment of lymph node metastasis, the diagnostic performance of combining parameters such as IC and Zeff with radiomics models is far superior to that of conventional morphological criteria. In predicting molecular biomarkers, spectral parameters are correlated with KRAS mutations and microsatellite instability (MSI) status. In treatment response assessment, baseline spectral CT parameters can predict chemotherapy efficacy and patient prognosis at an early stage. Conclusions: Spectral CT has important clinical application value in the precision diagnosis and treatment of colorectal cancer.