能谱CT平扫综合分析平台鉴别不同来源恶性浆膜腔积液的价值分析

The value of plain scan comprehensive analysis platform of spectrum CT in differentiating malignant serous effusion with different origin

目的探讨能谱CT平扫综合分析平台对不同来源恶性浆膜腔积液(MSE)的鉴别价值。方法回顾性分析2013年1月~2015年12月67例(男:女=33:34,年龄33~88岁)进行CT能谱成像(GSI),并经病理及影像学检查证实为MSE患者的平扫图像,按照原发肿瘤不同分为肺癌组(L组,32例,35个浆膜腔),卵巢癌组(O组,17例,24个浆膜腔),胃癌组(G组,18例,20个浆膜腔)。应用GSI综合分析平台,由两位观察者分别测量3组图像的常规混合能量CT值、不同单能量条件下CT值(40~140ke V每间隔10ke V)、有效原子序数(Effective-Z)值以及不同基物质对浓度值,包括钙(水)、脂(水)、水(脂)浓度,并计算能谱曲线斜率(k值)。采用组内相关系数(ICC)检验两位观察者测量数据的一致性,并对上述所有参数采用单因素方差分析(ANOVA)进行3组间两两比较。结果两位观察者获得的各项数据的一致性良好(ICC>0.75)。3组积液的混合能量CT值间差异均无统计学意义(P>0.05)。40 ke V条件下L、G、O组积液CT值分别为(19.10±8.63)HU、(29.12±4.21)HU、(40.90±11.58)HU,50 ke V条件下3组积液CT值分别为(15.57±4.76)HU、(23.35±4.25)HU、(30.91±8.41)HU,60ke V条件下3组积液CT值分别为(13.30±6.49)HU、(19.68±5.62)HU、(24.58±6.58)HU,其组间差异均有统计学意义(P<0.05);70ke V条件下,L、O组、L、G组间有差异(P<0.05),80 ke V条件下,L、O组间有差异(P<0.05),90~140ke V条件下3组积液CT值间差异均无统计学意义(P>0.05);k值、Effective-Z值以及钙(水)、脂(水)、水(脂)浓度值在L、O组,G、O组间有差异(P<0.05)。结论能谱CT平扫GSI综合分析平台中的低能量图像(40~60ke V)可以有效区分不同来源的MSE。

Objective To investigate the value of plain scan comprehensive analysis platform of spectrum CT in differentiating malignant serous effusion （MSE） with different origin. Methods Retrospective analysis 67 cases of CT plain scan images （ from January 2013 to December 2015, M： F = 33：34, age 33 -88 years）, which were performed by Gemstone Spectral Imaging （GSI） , and the pathological and radiological examination were confirmed MSE. According to the different origin divided into three groups： lung cancer group （group L, 32 cases, 35 serous cavity） , ovarian cancer group （group O, 17 cases, 24 serous cavity） , gastric cancer group （group G, 18 cases, 20 serous cavity）. Application of GSI comprehensive analysis platform, the parameters of 3 groups were measured by two observers, included the conventional mixing energy CT value, monochromatic images （40 - 140 keV） CT values, the effective atomic number （Effective-Z） and the concentration values of different base material, included cal- cium（water）, fat（water） and water（fat） concentrations, and calculated the slope of the curve （k value）. The intra-class corre- lation coefficients （ICC） was used to check the consistency of the data measured by the two observers, and the one-way ANOVA was used to compare all the parameters among three groups. Results The consistency of the data obtained by the two observers were good （ ICC value 〉 0.75 ）. The conventional mixing energy CT values of 3 groups had no significant difference （ P 〉 0. 05）. Under 40 keV condition, the CT values of group L, G, O were （ 19.10 ±8.63） HU, （29.12 ±4.21 ） HU, （40.90 ±11.58） HU （P 〈0.05）. Under 50 keV condition, the CTvalues of group L, G, O were （15.57±4.76） HU, （23.35± 4. 25 ） HU, （30.91 ± 8.41 ） HU （ P 〈 0.05 ）. Under 60 keY condition, the CT values of group L, G, O were （ 13.30 ± 6.49） HU, （ 19.68 ± 5.62） HU, （24.58 ± 6.58） HU （ P 〈 0.05 ）. Under 70 keV condition, group L and O, group L and G had sig-nificant difference （ P 〈 0.05 ）. Under 80 keV condition, group L and O had significant difference （ P 〈 0.05 ）. Under 90 to 140 keV condition, there were no significant difference among 3 groups （ P 〉 0.05 ）. The k value, Effective-Z value and the cal- cium（water）, fat（water）, water（fat） concentration values had significant difference in group L and O, group G and O （ P 〈 0. 05）. Conclusion The low energy images （40 - 60 keV） of spectrum CT plain scan GSI comprehensive analysis platform can effectively distinguish different origin of MSE.