能谱CT多参数成像在鉴别肺癌病理类型中的价值

Application of spectral CT multi-parameter in differentiating pathological types of lung cancer

目的:探讨能谱CT多参数成像在鉴别肺癌病理类型中的应用价值。方法:收集行能谱CT肺癌检查患者57例,其中腺癌24例,鳞状细胞癌18例,小细胞肺癌15例。采用能谱双期(主动脉期和肺静脉期)增强扫描,测量动脉期肿瘤40~90 keV单能量CT值、碘浓度、水浓度、有效原子序数(Z_(eff))及同层面主动脉碘浓度、水浓度,计算肺肿瘤标准化碘浓度(NIC)、标准化水浓度(NWC)及40~90 keV能谱曲线斜率(λ_(40~90 keV))。采用单因素方差分析比较3组测量参数。结果 :肺腺癌、鳞状细胞癌和小细胞肺癌40~60 keV单能量CT值、λ_(40~90 keV)(1.75±0.83、1.60±0.43、0.83±0.46)、碘浓度[(11.62±5.83)、(10.62±1.64)、(6.13±3.40)μg/mL]、NIC(0.090±0.046、0.085±0.014、0.060±0.040)、Z_(eff)(8.39±0.45、8.34±0.22、7.93±0.24)间差异均有统计学意义(均P<0.05)。70~90 keV单能量CT值、水浓度、NWC在腺癌、鳞状细胞癌、小细胞肺癌间差异均无统计学意义(均P> 0.05)。腺癌和鳞状细胞癌碘浓度、NIC、Z_(eff)、40~60 keV的CT值、λ_(40~90 keV)与小细胞肺癌各参数间差异均有统计学意义(均P<0.05),但腺癌与鳞状细胞癌各参数差异均无统计学意义(均P> 0.05),其中腺癌各参数值高于鳞状细胞癌。结论:能谱CT多参数成像可为肺癌分型提供多参数鉴别依据,为临床制订合理治疗方案和改善预后提供帮助。

Objective:To explore the application of spectral CT multi-parameter in differentiating pathological types of lung cancer.Methods:57 patients with lung cancer who underwent spectral CT imaging were collected,of which there were 24 cases with adenocarcinoma,18 cases with squamous cell carcinoma and 15 cases with small cell lung cancer.The dual-phase(aortic phase and pulmonary venous phase)enhanced scanning was used for all patients.The CT values of 40~90 keV,iodine concentration(IC),water concentration(WC),effective-Z(Zeff)and the IC and WC of aorta at the same level were measured in the arterial phase,and the normalized iodine concentration(NIC),the normalized water concentration(NWC)and the spectral curve slope(λ40~90 keV)were calculated.One-way ANOVA was used to compare the parameters of the three groups.Results:The CT values of 40~60 keV,IC,NIC,Zeff andλ40~90 keV showed significant differences among the three types of lung cancer(all P<0.05).There were no significant differences in CT values of 70~90 keV,WC and NWC among adenocarcinoma,squamous cell carcinoma and small cell lung cancer(all P>0.05).The CT values of 40~60 keV,IC,NIC,Zeff andλ40~90 keV in adenocarcinoma and squamous cell carcinoma were significantly different from those in small cell lung cancer(all P<0.05),but there were no significant differences between adenocarcinoma and squamous cell carcinoma(all P>0.05)and the parameters in adenocarcinoma were higher than those in squamous cell carcinoma.Conclusion:Spectral CT imaging can provide multi-parameter identification basis for the pathological types of lung cancer,which is helpful to determine the reasonable treatment plan and improve the prognosis.