目的 探讨宝石能谱CT成像技术 对食管癌术前分期的临床价值。方法 收 集85例经手术病理证实为食道癌患者的影 像资料，依据病理结果将其分为低分化 组(n=23)、中分化组(n=24)和高分化组 (n=17)，术前均行胸部平扫、双期增强扫 描，采用GSI模式，分析其诊断价值。结 果 三组病灶部位及肿瘤大小对比差异无 统计学意义(P>0.05)；在40～100keV单能 量下，CT值从高到低依次为低、中、高分 化组(P<0.05)；低分化组的碘浓度、NIC 显著高于中、高分化组(P<0.05)，三组间 水浓度对比差异无统计学意义(P>0.05)； 对低、中-高分化组的碘浓度和NIC做ROC 曲线发现，碘浓度的曲线下面积(AUC)为 0.655，NIC的为0.826；碘浓度诊断低、 中-高分化食管癌的灵敏度和特异度分别 为56.52%和53.66%，动脉期NIC分别为 73.91%和78.05%。结论 宝石能谱CT成像 技术中动脉期NIC对鉴别低、中-高分化癌 有较高诊断价值，有潜能用于食道癌术前 病理分级评估。

Objective To explore the clinical value of gemstone spectral CT imaging technique in preoperative staging of esophageal cancer. Methods The imaging data of 85 cases of patients with esophageal cancer which confirmed by operation and pathology were collected. According to pathological results, they were divided into low differentiation group (n=23), moderate differentiation group (n=24) and high differentiation group (n=17). Before operation, they were given chest plain scan and dual-phase enhanced scanning by using GSI mode, and the diagnostic value was analyzed. Results There was no significant difference in the lesion location and tumor size among the three groups (P>0.05). At 40-100 keV single energy, the CT values of lung cancer in low, medium and high differentiation groups were in turn from high to low(P<0.05). The iodine concentration and NIC in low differentiation group were significantly higher than those in moderate and high differentiation groups (P<0.05), and there was no significant difference in the water concentration among the three groups (P>0.05). The ROC curves for iodine concentration and NIC of low, moderate and high differentiation groups showed that the area under curve (AUC) of iodine concentration was 0.655, and the AUC of NIC was 0.826. The sensitivity and specificity of iodine concentration for the diagnosis of lowly, moderately and highly differentiated esophageal cancer were 56.52% and 53.66% respectively, and the two indexes of arterial phase NIC were 73.91% and 78.05%. Conclusion In gemstone energy spectrum CT imaging, NIC in arterial phase has high diagnostic value in differentiating low-to medium-to High-differentiated cancers, and has potential to be used in preoperative pathological grading of esophageal cancer. NIC