单源双能CT平扫能谱综合分析鉴别诊断卵巢子宫内膜异位囊肿和卵巢输卵管积脓或积水

Differential Diagnosis of Ovarian Endometriosis and Ovarian Pyosalpinx and Hydrosalpinx Using Single-source Dual-energy CT Energy Spectrum Comprehensive Analysis

目的基于卵巢子宫内膜异位囊肿(OE)和卵巢输卵管积脓或积水(OP/OH)间囊液成分的差异,探讨单源双能CT综合分析对OE和OP/OH的鉴别诊断价值。资料与方法回顾性分析2011年7月—2017年4月于大连医科大学附属第一医院放射科应用单源双能CT行宝石能谱成像(GSI)扫描,并经手术病理证实的20例OE患者及13例OP/OH患者。分别测量各病变最大囊腔囊液不同单能量(40~140 ke V)的CT值、有效原子序数、钙(水)浓度、脂(水)浓度、血(水)浓度,并计算能谱曲线斜率(K值)。比较各能谱参数的差异,使用受试者工作特性(ROC)曲线评估存在差异的参数对OE的诊断价值。结果 OE组40~60 ke V单能量CT值、K值均高于OP/OH组,差异有统计学意义(P<0.05)。两病变囊液70~140 ke V单能量CT值、有效原子序数、钙(水)浓度、脂(水)浓度、血(水)浓度值差异均无统计学意义(P>0.05)。40~60 ke V单能量CT值、K值诊断OE的AUC值分别为0.717(95%CI 0.581~0.902)、0.707(95%CI 0.556~0.884)、0.701(95%CI 0.555~0.885)、0.703(95%CI 0.541~0.889)。其中40 ke V单能量下CT值的诊断效能最高,当阈值为43.74 HU时,诊断OE的敏感度为54.5%,特异度为94.1%。结论 40~60 ke V单能量CT值、K值对OE和OP/OH的鉴别诊断具有重要的辅助信息。单源双能CT能谱综合分析平台为OE和OP/OH的鉴别诊断提供了重要信息。

Purpose To explore the diagnostic value of single-source dual-energy CT in differentiating ovarian endometriosis(OE)and ovarian pyosalpinx/ovarian hydrosalpinx(OP/OH)based on the difference in the cystic fluid composition.Materials and Methods Twenty OE and 13 OP/OH patients confirmed by operation and pathology who underwent gemstone spectral imaging(GSI)scanning with single-source dual-energy CT in Department of Radiology,the First Affiliated Hospital of Dalian Medical University from July 2011 to April 2017 were retrospectively analyzed.The CT values,effective atomic number,calcium(water)concentration,lipid(water)concentration and blood(water)concentration of cyst liquid in maximum cyst cavity for each lesion under different single energy(40-140 keV)were measured,and the slope of the energy spectrum curve(K value)was calculated.These indicators were compared,and the diagnostic value of the different indicators in OE was evaluated using ROC curve.Results The 40-60 keV CT value and K value in OE group were higher than those in OP/OH group,with a statistical significant difference(P<0.05).There was no significant difference in 70-140 keV CT value,effective atomic number,calcium(water)concentration,lipid(water)concentration and blood(water)concentration(P>0.05).The AUC value of CT value and K value in diagnosing OE under 40-60 keV single energy were 0.717(95%CI 0.581-0.902),0.707(95%CI 0.556-0.884),0.701(95%CI 0.555-0.885)and 0.703(95%CI 0.541-0.889),respectively.The CT value at single energy of 40 keV had highest diagnostic efficiency,with cutoff value of 43.74 HU,the sensitivity and specificity in diagnosing OE was 54.5%and 94.1%,respectively.Conclusion The CT value and K value at 40-60 keV from single-source dual-energy CT energy spectrum comprehensive analysis platform provide important auxiliary information in differentiating OE from OP/OH.