双源CT双能量扫描对肺良恶性病变的鉴别诊断

Dual CT dual-energy scanning in the differential diagnosis of benign and malignant pulmonary lesions

目的:探讨双源CT双能量扫描对鉴别诊断肺部良恶性肿块的价值。方法:选取72例肺肿块患者为研究对象,其中40例肺癌患者为观察组,32例炎性病变患者为对照组,72例患者均行双源CT双能量扫描,比较不同病变容积平均CT值、容积CT剂量指数值、平均容积CT增强值、容积CT净增值以及在不同keV下CT值衰减曲线,并计算不同标准化碘含量(NIC)阈值下CT检查的敏感度。结果:1观察组肿块体积、容积平均CT值、容积CT剂量指数值、平均容积CT增强值、容积CT净增值明显高于对照组,差异均有统计学意义(P<0.05);2不同keV下腺癌和鳞癌CT值明显低于炎性病变,差异均有统计学意义(P<0.05),但腺癌与鳞癌之间差异无统计学意义(P>0.05);三组病变CT值曲线斜率分别为(-1.07±0.51)、(-1.12±0.41)及(-2.18±0.52),腺癌与鳞癌之间差异无统计学意义(P>0.05),但均大于炎性病变(P<0.05);3观察组NIC值为(0.273±0.089)mg/mL,明显低于对照组(0.417±0.107)mg/mL,差异有统计学意义(P<0.05),对其进行ROC曲线分析得出NIC取值0.408mg/mL时,双源CT鉴别诊断良恶性病变的敏感度为0.862,特异度为0.626,曲线下面积为0.757,差异有统计学意义(P<0.05)。结论:应用双源CT双能量扫描能对肺部良恶性病变在体积上进行鉴别,并且能通过不同keV CT值曲线斜率对肺部良恶性病变进行鉴别。

Objective：To explore the application of dual CT dual-energy scanning in the differential diagnosis of benign and malignant pulmonary mass.Methods：72patients with pulmonary mass were selected for this study,including 40 lung cancer patients as study group and 32 patients with inflammatory lesions as control group.All 72 cases underwent dual CT dual-energy scanning.The mean volume CT value,dose index value of volume CT,mean increased value of volume CT,net-increased value of volume CT and attenuation curve of CT value under different keV of different pulmonary lesions were compared,the sensitivity of CT with different threshold of normalized iodine concentration（NIC）were calculated.Results：①The mass volume,volume average CT value,dose index value of volume CT,average increased value of volume CT,net-increased value of volume CT of the study group were significantly higher than that of control group,with statistical difference（P〈0.01）;②The CT value of adenocarcinoma and squamous cell carcinoma in different keV was significantly lower than that of inflammatory lesions（P〈0.05）,but there was no statistical difference between adenocarcinoma and squamous cell carcinoma（P〉0.05）.Curve slope of 3groups were（-1.07±0.51）,（-1.12±0.41）and（-2.18±0.52）respectively,there was no statistical difference between adenocarcinoma and squamous cell carcinoma（P〉0.05）,but they were all higher than that of inflammatory lesions（P〈0.05）;③The NIC of study group was（0.273±0.089）mg/mL,which was significantly lower than that of control group（0.417±0.107）mg/mL（P〈0.05）.Taking the NIC value 0.408mg/mL as the threshold,the sensitivity for differentiating benign and malignant lung lesions of dual source dual energy CT was 0.862,the specificity was 0.626,the area under the curve was 0.757,with statistical difference（P〈0.05）.Conclusion：Application of dual source dual energy CT can identify benign and malignant lung lesions in volume,and also can identify benign and malignant lung lesions through the curve slope of CT value in different keV.