肺癌能谱CT相关参数定量与临床应用

Quantification of Energy Spectrum CT Parameters in the Diagnosis of Lung Cancer and Clinical Application

目的探讨能谱CT参数在肺癌诊断及病理分型中的应用价值。方法搜集发现肺部占位行胸部能谱CT平扫及双期增强扫描患者110例,选取病灶短径>2 cm者共97例(包括鳞癌28例,腺癌41例,大细胞癌4例,小细胞癌7例,炎性病灶17例)分成5组。测量各组肺部原发病灶的能谱CT参数[包括碘浓度(IC)、标准化碘浓度(NIC)、水浓度(WC)、K40~90 keV和有效原子序数(Eff-Z)]。结果(1)肺癌与炎性病灶比较:肺癌平扫IC、K40~90 keV、Eff-Z测值及动、静脉期肺癌IC、K40~90 keV、NIC测值均小于炎性;肺癌平扫、静脉期WC测值大于炎性(P<0.05)。(2)不同病理类型肺癌比较:鳞癌与腺癌平扫IC、K40~90 keV、WC和Eff-Z、动脉期和静脉期IC、K40~90 keV和WC、静脉期NIC测值有统计学差异;鳞癌与小细胞癌静脉期NIC测值有统计学差异;腺癌与小细胞癌平扫IC和K40~90 keV、静脉期IC、K40~90 keV和NIC有统计学差异(P<0.05)。(3)以鳞癌和腺癌代表非小细胞癌,ROC曲线示:平扫WC诊断肺癌、静脉期NIC诊断非小细胞癌、静脉期IC和K40~90 keV诊断腺癌曲线下面积分别为0.745、0.913、0.852和0.853(P<0.05)。结论能谱CT测量平扫IC、K40~90 keV、WC和Eff-Z、动脉期IC、K40~90 keV和NIC、静脉期IC、K40~90 keV、NIC和WC可用于肺癌与炎性病灶的鉴别以及肺癌病理分型,其中平扫WC值大于1021.6诊断肺癌、静脉期NIC大于0.375诊断非小细胞癌、静脉期IC大于17.6或静脉期K40~90 keV大于2.355诊断腺癌均具有较高效能。

Objective To explore the application value of energy spectrum CT parameters in the diagnosis and pathological classification of lung cancer.Methods A total of 110 patients with lung space-occupying lesion chest scans and dual-phase enhanced CT scans were collected in our hospital from March 2017 to January 2019.A total of 97 patients(including 28 squamous cell carcinomas)with lesions>2 cm were selected.Cases comprised of 41 cases of adenocarcinoma,4 cases of large cell carcinoma,7 cases of small cell carcinoma,17 cases of inflammatory lesions)were divided into 5 groups.The energy spectrum CT parameters(including IC,NIC,WC,K40~90 keV and Eff-Z)of the primary lung lesions in each group were measured.Results(1)Comparison of lung cancer and inflammatory lesions:the values of IC,P,Eff-Z in plain scan and IC,P,NIC in arterial and venous phase of lung cancer were all less than that of inflammatory lesions;the values of WC in plain scan and venous phase were greater than that of inflammatory lesions(P<0.05).(2)Comparison of different pathological types of lung cancer:There was significant difference in the values of IC,P,WC,Eff-Z in plain scan and IC,P,WC in arterial and venous phase and NIC in venous phase between squamous cell carcinoma and adenocarcinoma;the difference of NIC in venous phase between squamous cell carcinoma and small cell carcinoma was statistically significant;as well as the difference of IC,P in plain scan and IC,P,NIC in venous phase between adenocarcinoma and small cell carcinoma was also statistically significant(P<0.05).(3)Squamous cell carcinoma and adenocarcinoma as representatives of non-small cell carcinoma.ROC curve indicated that the AUC of lung cancer diagnosed by WC in plain scan,non-small cell carcinoma diagnosed by NIC in venous phase,and adenocarcinoma diagnosed by IC and P in venous phase were 0.745,0.913,0.852 and 0.853,respectively(P<0.05).Conclusion Energy spectrum CT measurement of plain scan IC,K40~90 keV,WC and Eff-Z,arterial phase IC,K40~90 keV and NIC,venous phase IC,K40~90 keV,NIC and WC can be used for lung cancer and inflammatory lesions differentiation and pathological classification of lung cancer.The plain scan WC value greater than 1021.6 can diagnose lung cancer,the venous stage NIC greater than 0.375 can diagnose non-small cell carcinoma,the venous stage IC is greater than 17.6,or the venous stage P greater than 2.355 can diagnose adenocarcinoma.