宝石能谱CT在胸膜原发肿瘤诊断中的价值初探

Spectral CT: preliminary study in the diagnosis of primary pleural tumor

目的：探讨宝石能谱CT在胸膜原发肿瘤术前诊断中的应用价值。方法回顾性分析19例胸膜原发肿瘤患者的临床病历资料、CT图像特征和能谱参数，包括不同keV水平下的CT值，碘、水浓度及良恶性病变的能谱曲线斜率等，并进行统计学分析。结果恶性病变8例：恶性胸膜孤立性纤维性肿瘤（SFTP）3例，胸膜间皮瘤3例，滑膜肉瘤2例；良性病变11例：神经鞘瘤9例，良性SFTP 1例，脂肪瘤1例。恶性与良性肿瘤（除外脂肪瘤）能谱参数比较，恶性肿瘤平均碘浓度及平均水浓度为（14.05±8.82）g/L、（1027.32±8.64），良性肿瘤平均碘浓度及平均水浓度为（6.38±5.33）g/L、（1016.44±11.94）；恶性肿瘤能谱曲线斜率为（1.40±0.70），良性肿瘤能谱曲线斜率为（0.85±0.54）；40~110 keV条件下恶性肿瘤CT值大于良性肿瘤，且差异具有统计学意义（P﹤0.05）。结论不同病理类型的胸膜原发肿瘤具有一定的能谱CT特征，CT图像和能谱参数的结合对胸膜原发肿瘤良恶性的判断具有一定的价值。

Objective To study the value of spectral CT in the preoperative diagnosis of primary pleural tumors. Method Nineteen patients with primary pleural tumors were enrolled in the study. All patients were administered with spectral CT with gemstone spectral imaging （GSI）. The measurement of CT values of each lesions on images in varying keV was obtained. The GSI parameters of iodine-water concentration and spectral curve slope were recorded. The differ-ences of GSI parameters between the benign and malignant tumors were analyzed. Result Malignant tumors were con-firmed in 8 cases, including 3 cases of solitary fibrous tumors of the pleura （SFTP）, 3 cases of mesothelioma and 2 cases of synovial sarcoma; Benign tumors were determined in 11 cases, including 9 cases of schwannoma, 1 case of benign SFTP, 1 case of lipoma. The measurement of average iodine and water concentration of malignant tumors were （14.05 ± 8.82） g/L and 1027.32 ± 8.64, which of benign tumors were （6.38±5.33） g/L and 1016.44 ±11.94, respectively. The curve slope of malignant tumors was 1.40±0.70, and that of benign tumors was 0.85±0.54. The average CT value of malignant tumors was significantly greater than that of benign tumors on the images obtained at 40~110 keV （P〈0.05）. Conclusion：Primary pleural tumors of various etiologies are generally characterized on spectral CT. The combination of conventional CT imaging and spectral parameters is helpful in distinguishing benign tumors from malignant tumors.