双源CT能谱参数在肠道肿瘤转移性淋巴结及反应增生性淋巴结鉴别中的应用

Application of dual-source CT energy spectrum parameters in differential diagnosis of the metastatic lymph nodes and the hyperplastic lymph nodes

目的:探讨双源CT能谱参数在肠道肿瘤转移性淋巴结与反应性增生淋巴结鉴别诊断中的价值。方法:对25位患者在双源CT上行小肠造影检查,共3期扫描,即常规平扫、动脉期和静脉期对比增强双能量扫描100kV/140kV,将双能量扫描2组数据(140kV,100kV)调入Dual-Energy后处理软件。利用Liver-VNC选项卡,调整融合比例为100%得到碘分布伪彩图,测量碘图中肠道肿瘤原发病灶与腹部区域淋巴结的碘值;选取Mono Energetic选项卡对其进行能谱曲线分析。比较原发病灶、转移性淋巴结与反应性增生淋巴结碘含量及能谱曲线斜率的差异。得到所有数据后,采用SPSS 21.0软件进行统计分析,计量资料以均数±标准差表示,采用单个样本t检验比较3组图像的碘值及能谱曲线斜率,若有统计学差异,再采配对t检验两两之间进行比较。结果:术后病理证实25例肠道肿瘤患者中,原发灶25个,共发现腹部区域淋巴结50枚,其中转移性淋巴结29枚,反应性增生淋巴结21枚。原发病灶与反应性增生淋巴结、转移性淋巴结碘含量分别为(1.544±0.302)mg/mL、(2.157±0.505)mg/mL、(1.355±0.254)mg/mL,曲线斜率分别为0.683±0.374、0.553±0.120、0.710±0.351,三者碘含量及曲线斜率的差异均有统计学意义(P均<0.05);两两之间仅原发病灶与转移性淋巴结间碘含量及曲线斜率的差异无统计学意义(P均>0.05)。结论:患者小肠造影的检查中双源CT双能量扫描碘含量及能谱曲线斜率对肠道肿瘤转移性淋巴结及反应性增生淋巴结鉴别诊断具有一定的价值。

Objective：To explore the value of dual-source CT energy spectrum parameters in differential diagnosis of the metastatic lymph nodes and the reactive hyperplasia lymph nodes in intestinal tumors.Methods：Twenty-five patients were examined by double-source CT of the small intestine including conventional plain scan using arterial phase and venous phase contrast enhanced dual-energy scan 100 kV/140 kV.The two-energy scan 2 sets of data（140 kV,100 kV）analysis were used by the dual-energy post-processing software.Using the liver-VNC tab,the fusion ratio of 100% was adjusted to obtain iodine distribution pseudo-color map to measure the iodine value of the primary tumor of the intestine and the lymph node in the abdominal area;the Mono Energetic tab was adopted to analyze the spectrum.The iodine content of primary lesion,metastatic lymph node and reactive hyperplasia lymph node and the slope of the difference were compared.After the data were obtained,SPSS 21.0 software was used for statistical analysis.The measured data were expressed as mean±standard deviation.The iodine value and slope of the energy spectrum of the three groups were compared by a single sample t test.If there were statistical differences,the comparison was made between the two t-test tests.Results：Postoperative pathology confirmed that in 25 cases of intestinal cancer patients,with 25 primary tumors,50 lymph nodes were found in the regional area;from these,there were 29 metastatic lymph nodes and 21 reactive hyperplasia lymph nodes.The content of iodine in the primary lesion,reactive lymph nodes and metastatic lymph nodes were（1.544±0.302）mg/mL,（2.157±0.505）mg/mL,and（1.355±0.254）mg/mL respectively.The slopes of the curve was 0.683±0.374,0.553±0.120,and0.710±0.351.The differences in iodine content and slopes of the curve among the primary lesion,reactive lymph nodes and metastatic lymph nodes were statistically significant（P〈0.05）.There was no significant difference in iodine content and slope of curve between primary lesion and metastatic lymph nodes（P〉0.05）.Conclusion：The iodine content and slope of energy spectrum curve of Dual-energy CT scanning has certain value in the differential diagnosis of metastatic lymph nodes and reactive hyperplasia lymph nodes in patients with small bowel tumor.