一站式CT能谱联合灌注成像技术在肺癌病理类型鉴别中的应用研究

The study on the application of one-step spectral and perfusion CT imaging in the diagnosis of lung cancer

目的:研究一站式CT能谱联合灌注成像技术在肺癌诊断中的应用价值。方法:收集在本院就诊患肺癌的患者,所有患者均采用Aquilion ONE 640层CT扫描仪进行能谱联合灌注扫描,最后经病理证实病灶分别为鳞状细胞癌24例,腺癌29例,小细胞肺癌8例。采集图像后应用Dual Energy能谱处理程序处理每一组能谱数据,通过碘图测得病灶及同层主动脉的碘基值(IC),并获得标准化碘基值(NIC);经Vitrea工作站采用80 kVp水平能谱数据联合原始灌注数据重建获得灌注图像,获得病灶支气管动脉血流(AF)、肺动脉血流(PF)和血流灌注指数(PI)。所有数据均测量三次并取平均数。肺鳞癌腺癌之间的能谱、灌注参数值的差异比较均采用独立样本t检验,有统计学差异的参数采用ROC曲线分析。以P<0.05为差异具有统计学意义。结果:肺腺癌组IC、NIC、AF、PF值高于肺鳞癌组,PI值低于肺鳞癌组,其中,IC、NIC、AF、PI差异具统计学意义(P<0.05),AUC分别为0.717、0.899、0.79、0.746,同时联合IC、NIC、AF及PI用于肺鳞癌、肺腺癌之间鉴别诊断时,AUC为0.943,敏感度、特异度分别为86.2%、95.8%。结论:参数IC、NIC、AF及PI值有助于对肺腺癌、肺鳞癌之间的鉴别诊断,同时联合这四种参数值可以提高诊断效能,敏感度及特异度,有助于对肺癌病理类型进行预判。

Objective:To investigate the application value of one-step spectral and perfusion imaging with Aquilion ONE 640-slice CT scanner in the diagnosis of lung cancer.Methods:Patients with confirmed pulmonary nodules who were collected and underwent one-step spectral and perfusion imaging.Pathologically confirmed lesions were 24 squamous cell carcinomas,29 adenocarcinomas,and 8 small cell lung cancers.After the images were acquired,the energy spectrum data of each group was processed in the Dual Energy processing program,the iodine concentration(IC)of the lesion and the aorta in the same layer were measured in the generated iodine map,and the standardized iodine concentration(NIC)was abtained.CT perfusion images were reconstructed by primary perfusion data and 80 kVp energy level images which generated from spectral CT through Vitrea workstation.CT perfusion parameters included arterial flow(AF),pulmonary flow(PF)and perfusion index(PI).All the aforem entioned data were measured three times and averaged.Comparison of energy spectrum and perfusion parameter difference between lung squamous cell carcinoma and adenocarcinoma were analyzed by adopting independent sample t test,and parameters with statistical differences were further analyzed by receive operating characteristic(ROC)curve.The difference(P<0.05)was considered statistically significant.Results:The IC,NIC,AF,and PF in lung adenocarcinoma were higher than that in lung squamous cell carcinoma,and PI was lower than that in lung squamous cell carcinoma group.Additionally,statistically significant differences were found for IC,NIC,AF,and PI between two types of lung cancer(P<0.05),and the AUC were 0.717,0.899,0.79,0.746,respectively.When IC,NIC,AF and PI were combined for in the differential diagnosis of lung squamous cell carcinoma and lung adenocarcinoma,the AUC was 0.943,and the sensitivity and specificity were 86.2%and 95.8%,respectively.Conclusion:The difference in IC,NIC,AF,and PI values between lung adenocarcinoma and lung squamous cell carcinoma were statistically significant,and the combination of four parameter values could improve the diagnostic sensitivity and specificity.One-step spectral and perfusion imaging is feasible in the assessment of lung squamous cell carcinoma and adenocarcinoma.