宝石能谱CT在孤立性肺结节鉴别诊断中的价值

The value of gemstone spectral CT imaging in characterizing the benign and malignant solitary pulmonary nodules

目的探讨宝石能谱CT在孤立性肺结节（SPN）诊断及鉴别诊断中的应用价值。方法回顾性分析接受胸部CT高压三期检查的32例SPN病例资料。所有病例经手术、穿刺活组织检查后病理证实。所有检查均在宝石能谱CT上进行，扫描完成后将单能量图像载入宝石能谱成像浏览器（GSIviewer）软件上，对SPN的能谱曲线图及碘基图像碘含量和水基图像水含量进行分析。结果肺鳞状细胞癌、肺腺癌、错构瘤、硬化性血管瘤、炎性假瘤碘含量分别为（11．66±2．72）μg／ml、（12．36±2．97）μg／ml、（10．20±3．11）μg／ml、（16．58±3．58）μg／ml、（21．67±3．76）μg／ml，肺腺癌及肺鳞状细胞癌的碘含量之间差异无统计学意义（P〉0．05），其他不同结节的碘含量之间差异均有统计学意义（均P〈0．05）。肺鳞状细胞癌、肺腺癌、错构瘤、硬化性血管瘤、炎性假瘤的水含量分别为（1021．31±13．83）μg／ml、（1027．98±12．53）μg／ml、（1003．42±13．67）μg／ml、（1029．61±12．06）μg／ml、（1051．61±13．81）μg／ml，各类不同结节的水含量之间差异无统计学意义（均P〉0．05）。结论宝石能谱CT成像通过应用碘含量测定，对鉴别不同来源的SPN有较大意义，可以提高SPN良恶性鉴别诊断的敏感性及特异性。

Objective To explore the value of gemstone spectral imaging （GSI） with single source dual-energy CT in characterizing the benign and malignant solitary pulmonary nodules （SPN）. Methods Totally 32 patients with SPN underwent phase m enhanced CT scan using single source dual-energy CT by GSI mode. Three types of images were reconstructed for analysis： the water concentration （WC）, iodine concentration （IC） and normalized iodine concentration （NIC）. Results The IC of lung squamous cell carcinoma lung adenocarcinoma, hamartoma, sclerosing hemangioma, inflammatory pseudotumor were （11.66±2.72） μg/ml, （12.36±2.97） μg/ml, （10.20±3.11）μg/ml, （16.58±3.58） μg/ml, （21.67±3.76） μg/ml, the IC of lung adenocarcinoma and lung squamous cell carcinoma had no difference （P 〉 0.05）, there were significant differences in the value of iodine material between other nodules （all P 〈 0.05）. The WC of lung adenocarcinoma,lung squamous cell carcinoma, hamartoma, sclerosing hemangioma, inflammatory pseudotumor were （1 021.31±13.83） μg/ml, （1 027.98±12.53） μg/ml, （1 003.42±13.67） μg/ml, （1 029.61±12.06） μg/ml, （1 051.61±13.81） μg/ml, there was no significant difference in the value of water material between nodules （all P 〉 0.05）. Conclusion The spectral CT imaging may be helpful for characterizing the pathological type of SPN.