能谱CT多参数鉴别诊断肾上腺乏脂性腺瘤与结节性增生

Spectral CT multi-parameters in differential diagnosis of lipid-poor adrenal adenoma and adrenal nodular hyperplasia

目的观察能谱CT多参数鉴别诊断肾上腺乏脂性腺瘤(Lp-AA)与肾上腺结节性增生(ANH)的价值。方法回顾性分析经手术病理证实的Lp-AA(n=24,Lp-AA组)和ANH(n=20,ANH组)患者的常规CT平扫和动、静脉期能谱CT增强图像,比较组间动、静脉期标准化40~140 keV(间隔10 keV)单能量CT值、各基物质对浓度、有效原子序数及能谱曲线差异。针对差异有统计学意义的参数,绘制其鉴别Lp-AA与ANH的受试者工作特征(ROC)曲线,分析其诊断效能。结果组间动脉期标准化40~70 keV单能量CT值、碘-脂、脂-碘、钙-水、碘-水浓度、能谱曲线斜率差异均有统计学意义(P均<0.05),标准化有效原子序数及80~140 keV单能量CT值差异均无统计学意义(P均>0.05)。组间静脉期标准化40~50 keV单能量CT值、脂-碘、羟基磷灰石-水、碘-水浓度及标准化有效原子序数差异均有统计学意义(P均<0.05),其余参数差异均无统计学意义(P均>0.05)。上述参数鉴别Lp-AA与ANH的曲线下面积(AUC)为0.73~0.82,以碘-脂浓度的诊断效能最高,AUC为0.82。结论能谱CT多参数对鉴别Lp-AA与ANH具有一定价值。

Objective To observe the value of spectral CT multi-parameters in differential diagnosis of lipid-poor adrenal adenoma(Lp-AA)and adrenal nodular hyperplasia(ANH).Methods Routine plain CT scanning and arteriovenous energy spectrum images of patients with Lp-AA(Lp-AA group,n=24)and ANH(ANH group,n=20)confirmed by surgery pathology were retrospectively analyzed.The normalized CT values at 40-140 keV(10 keV interval)single energy,concentration of various base materials,effective atomic number and energy spectrum curves during the arterial and venous phases were compared between groups.The receiver operating characteristic(ROC)curves of parameters being statistically different between groups were drawn for differential diagnosis of Lp-AA and ANH,and the corresponding diagnostic efficacy were analyzed.Results In arterial phase,there were statistical differences of the normalized single-energy CT values at 40-70 keV single energy,concentrations of iodine-lipid,lipid-iodine,calcium-water and iodine-water between 2 groups(all P<0.05),while there was no statistical difference of the normalized effective atomic number nor single energy CT value at 80-140 keV(all P>0.05).In venous phase,statistical differences of the normalized 40-50 keV single energy CT values,lipid-iodine,HAP-water,iodine-water concentrations and effective atomic number were detected between groups(all P<0.05),but not of the other parameters(all P>0.05).The area under the curve(AUC)of the above parameters for distinguishing Lp-AA and ANH was 0.73-0.82,among which iodine-lipid concentration had the highest diagnostic efficiency,with the AUC of 0.82.Conclusion Energy spectrum CT multi-parameters had certain value for differentiation of Lp-AA and ANH.