能谱CT在鉴别肺腺癌、鳞癌和炎性肌纤维母细胞瘤中的价值

The value of spectral CT imaging in the differential diagnosis of adenocarcinoma, squamous carcinoma and inflammatory myofibroblastic tumor

目的 探讨能谱CT定量分析在鉴别肺腺癌、鳞癌和炎性肌纤维母细胞瘤（IMT）中的应用价值.方法 回顾性分析2015年10月至2017年5月我院病理证实的115例肺部结节或肿块的患者资料,其中肺腺癌62例、鳞癌33例和IMT 20例,所有患者均行能谱CT的能谱模式（GSI）扫描,获得动脉期（AP）和静脉期（VP）的能谱图像.分别测量肺腺癌、鳞癌和IMT的碘浓度,并计算动脉期标准化碘浓度（NICAP）、静脉期标准化碘浓度（NICVP）、动脉期和静脉期标准化碘浓度的差异（ICD）,对3组之间上述定量指标进行方差分析和ROC曲线分析.结果 肺腺癌的NICAP（0.15±0.04）、NICVP（0.37±0.08）和ICD（0.23±0.06）均小于IMT（0.21±0.05、0.50±0.06、0.28±0.08）,两者间NICAP、NICVP和ICD值的差异均有统计学意义（P〈0.05）.肺鳞癌的NICAP（0.13±0.03）、NICVP（0.35±0.06）和ICD（0.22±0.05）值也均小于IMT,两者间NICAP、NICVP和ICD值的差异均有统计学意义（P〈0.05）.肺腺癌和鳞癌的NICAP、NICVP和ICD值的差异均无统计学意义.鉴别肺腺癌和IMT最佳能谱定量参数是NICVP,其阈值为0.425时鉴别两者的敏感度和特异度分别为92.3%和86.7%.鉴别肺鳞癌和IMT的最佳能谱定量参数亦是NICVP,其阈值为0.440时,鉴别两者的敏感度和特异度分别为84.6%和92.3%.结论 能谱CT的碘浓度定量分析在在鉴别肺腺癌、鳞癌和IMT中有较大价值,一定程度上能提高诊断准确性.

Objective To explore the application value of spectral CT quantitative analysis in differentiating adenocarcinoma or squamous carcinoma from inflammatory myofibroblastic tumor （IMT）. Methods A total of 115 patients with 62 adenocarcinomas, 33 squamous carcinomas and 20 IMTs underwent spectral CT scans to obtain spectral images at arterial phase （AP） and venous phase （VP）. The imaging data were analyzed retrospectively. The iodine concentration of adenocarcinoma, squamous carcinomas and IMT were measured. The normalized iodine concentration in AP （NICAP）, normalized iodine concentration in VP （NICVP） and normalized iodine concentration difference between AP and VP （ICD） were calculated. The above quantitative parameters among three groups were analyzed with analysis of variance and ROC curve. Results NICAP （0.15 ± 0.04）, NICVP （0.37 ± 0.08） and ICD（0.23 ± 0.06）of the adenocarcinoma were lower than those of IMT （0.21 ± 0.05,0.50 ± 0.06,0.28 ± 0.08）. There were significant differences in NICAP, NICVP and ICD between adenocarcinoma and IMT （P〈0.05）. NICAP （0.13 ± 0.03）, NICVP （0.35±0.06） and ICD （0.22±0.05） of the squamous carcinoma were lower than those of IMT （0.21± 0.05,0.50±0.06,0.28±0.08）. The differences in NICAP, NICVP and ICD were significant between squamous carcinoma and IMT （P〈0.05）. There were no significant differences in NICAP, NICVP and ICD between adenocarcinoma and squamous carcinoma （P〉0.05）. The best spectral quantitative parameter for differentiating the adenocarcinoma from IMT was NICVP, which yielded a sensitivity of 92.3% and a specificity of 86.7%with the threshold of 0.425. NICVP was also the best spectral quantitative parameter for differentiating squamous carcinomas from IMT. With the threshold of 0.44, a sensitivity of 84.6% and a specificity of 92.3% were found. Conclusion Spectral CT imaging with the quantitative iodine concentration analysis may help to increase the accuracy of differentiating adenocarcinoma and squamous carcinoma from IMT.