双源CT双能量成像在孤立性肺肿块的诊断价值

Dual Energy CT Imaging in the Diagnosis of Solitary Pulmonary Nodules

目的探讨双源CT（DSCT）双能量成像技术在孤立性肺肿块诊断中的价值。方法对67例肺内孤立性肿块（恶性肿瘤48例,良性肿块19例）行DSCT常规增强及双能增强扫描,获得肿块动、静脉期常规增强与虚拟平扫及碘基图CT值、40~190 keV系列单能量图像CT值,并记录各肿块动、静脉期碘含量,计算动、静脉肿块能谱曲线斜率。利用F检验、t检验或ROC曲线对比分析能谱曲线、碘含量及碘基图CT值。结果动脉期肿块增强CT值与碘基图CT值差异无统计学意义（P〉0.05）,动脉期增强图像与碘基图CT值显示高度一致性,相关系数r=0.89;静脉期肿块增强CT值与碘基图CT值差异有统计学意义（P〈0.05）。动脉期在40~100 keV区间下肺恶性肿瘤、炎性肿块及结核瘤的CT值两两之间差异均有统计学意义（P〈0.05）;静脉期在40~110 keV下肺恶性肿瘤、炎性肿块及结核瘤的CT值两两之间差异均有统计学意义（P〈0.05）。以CT值18 HU作为肿块良恶性诊断阈值（〈18 HU为良性,≥18 HU为恶性）,碘基图CT值诊断孤立性肺肿块良恶性的敏感性为83.3%,特异性为76.2%,准确性为81.2%。动、静脉期恶性肿瘤、炎性肿块及结核球的碘含量均值分别为（1.00±0.07）mg/ml、（1.92±0.12）mg/ml、（0.46±0.05）mg/ml和（1.25±0.14）mg/ml、（2.06±0.18）mg/ml及（0.58±0.06）mg/ml;能谱曲线斜率均值分别为-0.96、-1.38、-1.97和-2.27、-0.45、-0.56,两期恶性肿瘤与炎性肿块、炎性肿块与结核球、恶性肿瘤与结核球间碘含量及能谱曲线斜率差异均有统计学意义（P均〈0.05）。结论采用DSCT双能量成像的参数进行定量分析,对孤立性肺肿块的良恶性鉴别诊断有较大价值。

Objective To investigate the dual source CT（ DSCT） value of dual energy imaging in solitary pulmonary tumor diagnosis. Methods Of 67 cases of pulmonary solitary masses（ 48 cases of malignant tumors and benign masses of19 cases） underwent DSCT routine enhanced and dual energy enhancement scanning to obtain the mass,venous phase enhancement of traditional and virtual Ping sweep and iodine ghitu CT value,40- 190 keV series single energy CT value and record each mass,iodine content in venous phase calculated artery and vein mass spectrum curve slope. Analysis of spectrum curve by using F test,t test and ROC curve comparison,Iodine and iodine content of base maps of CT values were done. Results The mass enhanced CT arterial iodine value chart CT value was no significant difference（ P 〉 0. 05）,arterial phase enhanced CT image and the iodine value distribution image display high degree of consistency,the correlation coefficient r = 0. 89; venous phase enhanced CT mass value there were significant differences in iodine distribution CT value（ P 〈 0. 05）. Under 40- 100 kev arterial phase interval,differences were statistically significant（ P 〈 0. 05） between the two lung cancer,inflammatory mass and CT value tuberculoma; venous phase in 40- 110 kev lung cancer,inflammatory differences were statistically significant（ P 〈 0. 05） between any two masses and CT value tuberculoma. CT values in benign and malignant tumors was 18 HU as diagnostic threshold（ 〈 18 HU benign,≥18 HU malignant）,benign and malignant iodine sensitivity in diagnosing solitary pulmonary tumors was 83. 3%,a specificity of 76. 2% and accuracy was81. 2%. Arteries and veins of cancer,inflammatory mass and the mean concentration of iodine tuberculoma were（ 1. 00 ±0. 07） mg / ml,（ 1. 92 ± 0. 12） mg / ml,（ 0. 46 ± 0. 05） mg / ml and（ 1. 25 ± 0. 14） mg / ml,（ 2. 06 ± 0. 18） mg / ml and（ 0. 58 ± 0. 06） mg/ml; mean of the energy curve slope were- 0. 96 and- 1. 38,- 1. 97 and- 2. 27,- 0. 45 and- 0. 56,two inflammatory malignant tumor,inflammatory mass with tuberculoma,iodine concentration content and spectrum slope difference between cancer and tuberculosis ball and were statistically significant（ P 〈 0. 05）. Conclusion DSCT dual energy imaging parameters for quantitative analysis,differential diagnosis of benign and malignant solitary pulmonary mass has greater value.