能谱CT成像对非小细胞肺癌患者淋巴结转移的诊断价值分析

Diagnostic Value of Energy Spectrum CT Imaging on Lymphatic Metastasis in Patients with Non-small Cell Lung Cancer

目的分析能谱CT成像对非小细胞肺癌(NSCLC)患者淋巴结转移的诊断价值。方法选取2016年8月—2018年8月在河北工程大学附属医院就诊的NSCLC患者58例,均行能谱CT成像检查。比较所有患者转移病灶与非转移病灶淋巴结短径,并比较所有患者转移病灶与非转移病灶淋巴结、原发病灶能谱曲线斜率(λHu)及其λHu比值、标准化碘(水)密度(NIC)及其NIC比值、标准化水(碘)密度(NWC)及其NWC比值、标化有效原子序数(Neff-Z)及其Neff-Z比值;以手术及病理学检查结果为"金标准",绘制四格表以分析能谱CT成像对NSCLC患者淋巴结转移的诊断价值,并绘制ROC曲线以分析淋巴结和原发病灶λHu比值、NIC比值在判断NSCLC患者淋巴结转移中的价值。结果 (1)NSCLC患者转移病灶淋巴结短径长于非转移病灶(P<0.01);绘制四格表发现,能谱CT成像诊断NSCLC患者淋巴结转移的灵敏度为90.00%,特异度为60.00%,准确率为69.47%。(2)NSCLC患者转移病灶淋巴结λHu、淋巴结和原发病灶λHu比值低于非转移病灶,原发病灶λHu高于非转移病灶(P<0.05);ROC曲线显示,淋巴结和原发病灶λHu比值诊断NSCLC患者淋巴结转移的曲线下面积(AUC)为0.791〔95%CI(0.737,0.823)〕,最佳临界值为1.35,灵敏度为88.6%,特异度为72.7%。(3)NSCLC患者转移病灶淋巴结NIC、淋巴结和原发病灶NIC比值低于非转移病灶,原发病灶NIC高于非转移病灶(P<0.05);ROC曲线显示,淋巴结和原发病灶NIC比值诊断NSCLC患者淋巴结转移的AUC为0.751〔95%CI(0.717,0.811)〕,最佳临界值为1.25,灵敏度为85.1%,特异度为73.4%。(4)NSCLC患者转移病灶与非转移病灶淋巴结、原发病灶NWC及其NWC比值比较,差异无统计学意义(P>0.05)。(5)NSCLC患者转移病灶与非转移病灶淋巴结、原发病灶Neff-Z比较,差异无统计学意义(P>0.05),而转移病灶淋巴结和原发病灶Neff-Z比值低于非转移病灶(P<0.05)。结论能谱CT成像诊断NSCLC患者淋巴结转移的灵敏度较高,而能谱CT参数淋巴结和原发病灶λHu比值、NIC比值在判断NSCLC患者淋巴结转移中有一定参考、应用价值,有利于提高临床判断NSCLC患者淋巴结转移的准确性。

Objective To analyze the diagnostic value of energy spectrum CT imaging on lymphatic metastasis in patients with non-small cell lung cancer(NSCLC).Methods A total of 58 patients with NSCLC were selected in the Affiliated Hospital of Hebei University of Engineering from August 2016 to August 2018,all of them underwent the examination of energy spectrum CT imaging. Short diameter of lymph node,λHu,NIC,NWC and Neff-Z of lymph node and primary focus,λHu ratio,NIC ratio,NWC ratio and Neff-Z ratio of lymph node to primary lesion were compared between metastatic lesion and nonmetastatic lesion;taking surgical and pathological examination results as "gold standard",four-fold table was drawn to analyze the diagnostic value of energy spectrum CT imaging on lymphatic metastasis in patients with NSCLC,ROC curve was drawn to analyze the diagnostic value of λHu ratio and NIC ratio of lymph node to primary lesion on lymphatic metastasis in patients with NSCLC,respectively. Results (1)Short diameter of lymph node in metastatic lesion was statistically significantly longer than that in non-metastatic lesion in patients with NSCLC(P<0.01);four-fold table showed that,the sensitivity,specificity and accuracy rate of energy spectrum CT imaging in diagnosing lymphatic metastasis of patients with NSCLC was 90.00%,60.00% and 69.47%,respectively.(2)λHu of lymph node and λHu ratio of lymph node to primary lesion in metastatic lesion were statistically significantly lower than those in non-metastatic lesion in patients with NSCLC,while λHu of primary focus in metastatic lesion was statistically significantly higher than that in non-metastatic lesion in patients with NSCLC(P<0.05);ROC curve showed that,AUC,optimum critical value,sensitivity and specificity of λHu ratio of lymph node to primary lesion in diagnosing lymphatic metastasis in patients with NSCLC was 0.791〔95%CI(0.737,0.823)〕,1.35,88.6% and 72.7%,respectively.(3)NIC of lymph node and NIC ratio of lymph node to primary lesion in metastatic lesion were statistically significantly lower than those in non-metastatic lesion in patients with NSCLC,while NIC of primary focus in metastatic lesion was statistically significantly higher than that in non-metastatic lesion in patients with NSCLC(P<0.05);ROC curve showed that,AUC,optimum critical value,sensitivity and specificity of NIC ratio of lymph node to primary lesion in diagnosing lymphatic metastasis in patients with NSCLC was 0.751〔95%CI(0.717,0.811)〕,1.25,85.1% and 73.4%,respectively.(4)No statistically significant difference of NWC of lymph node or primary focus,or NWC ratio of lymph node to primary lesion was found between metastatic lesion and non-metastatic lesion in patients with NSCLC(P>0.05).(5)No statistically significant difference of Neff-Z of lymph node or primary focus was found between metastatic lesion and non-metastatic lesion in patients with NSCLC(P>0.05),while Neff-Z ratio of lymph node to primary lesion in metastatic lesion was statistically significantly lower than that in non-metastatic lesion in patients with NSCLC(P<0.05). Conclusion Energy spectrum CT imaging has relatively high sensitivity in diagnosing lymphatic metastasis in patients with NSCLC,however λHu ratio and NIC ratio of lymph node to primary lesion have relatively high reference and application value in the diagnosis of lymphatic metastasis,which are helpful to improve the diagnostic accuracy on clinic.