双能光谱CT定量分析对肺腺癌化疗后疗效的评估价值

Value of dual-energy spectrum spectral CT quantitative analysis in evaluating the curative effect of chemotherapy for lung adenocarcinoma

目的研究肺腺癌患者化疗前后动静脉期能谱曲线斜率K值、标准化碘基值的变化,探讨能谱CT定量分析对肺腺癌患者化疗后疗效的评估价值。方法选择2019年10月至2020年10月南通大学附属东台医院收治的34例经病理确诊后临床需要化疗的肺腺癌患者34例,分别于化疗前、化疗后两个周期应用GE RevolutionCT机进行CT能谱增强扫描。化疗后按RECIS1.1标准,将29例部分缓解、病情稳定者归为有效组,5例病情进展者归为无效组,分别测量两组患者病灶内感兴趣区治疗前后动静脉期能谱曲线斜率K值及标准化碘基值。结果有效组患者治疗前动脉期和静脉期的能谱曲线斜率K值、标准化碘基值分别为2.28±0.80、2.30±0.81和0.18±0.08、0.45±0.14,治疗后动脉期、静脉期的能谱曲线斜率K值、标准化碘基值分别为1.81±0.30、2.10±0.50和0.13±0.03、0.40±0.06,治疗后患者的动脉期能谱曲线K值、标准化碘基值明显低于治疗前,差异均有统计学意义(P<0.05),而治疗后静脉期能谱曲线K、标准化碘基值均低于治疗前,差异均无统计学意义(P>0.05);无效组患者治疗前动脉期和静脉期的能谱曲线斜率K值、标准化碘基值分别为2.32±0.89、2.33±0.89和0.17±0.06、0.43±0.07,治疗后动脉期、静脉期的能谱曲线斜率K值、标准化碘基值分别为2.35±0.90、2.35±0.87和0.23±0.09、0.44±0.04,治疗后患者的动脉期标准化碘基值明显高于治疗前,差异均有统计学意义(P<0.05),而治疗后动脉期及静脉期的能谱曲线K值、静脉期的标准化碘基值较治疗前均稍有增高,差异均无统计学意义(P>0.05);治疗前,有效组和无效组患者的动静脉期能谱曲线斜率K值、标准化碘基值比较差异均无统计学意义(P>0.05);治疗后有效组患者的动脉期能谱曲线斜率K值、标准化碘基值明显低于无效组,差异均有统计学意义(P<0.05),而静脉期有效组和无效组患者的能谱曲线斜率K值、标准化碘基值比较差异均无统计学意义(P>0.05)。结论双能光谱CT定量分析对肺腺癌化疗的疗效评估具有一定的临床价值,可作为疗效评估的重要手段之一。

Objective To study the changes of slope K of energy spectrum curves and normalized iodine concentration in the arterial and venous phase before and after chemotherapy in patients with lung adenocarcinoma,and to discuss the evaluation value of dual-energy spectrum spectral CT quantitative analysis on the efficacy after chemotherapy in patients with lung adenocarcinoma.Methods From October 2019 to October 2020,34 patients with lung adenocarcinoma confirmed by pathology and scheduled for chemotherapy in Dongtai Hospital Affiliated to Nantong University were selected.All patients were treated with a GE Revolution CT scan before chemotherapy and 2 cycles after chemotherapy.According to RECIS1.1 standard,29 patients with partial remission and stable disease were classified as effective group,and 5 patients with disease progression were classified as ineffective group.Slope K of energy spectrum curves and normalized iodine concentration of the area of interest in the focus in the two groups were measured before and after treatment in the arterial and venous phase.Results In the effective group,slope K of energy spectrum curves and normalized iodine concentration were 2.28±0.80,2.30±0.81 and 0.18±0.08,0.45±0.14 in the arterial and venous phases before treatment,and 1.81±0.30,2.10±0.50 and 0.13±0.03,0.40±0.06 after treatment;the two indexes in arterial phase after treatment were significantly lower than those before treatment(P<0.05);however,the two indexes in venous phase after treatment were similar with those before treatment(P>0.05).In the ineffective group,the slope K value and normalized iodine concentration in the arterial and venous phases were 2.32±0.89,2.33±0.89 and 0.17±0.06,0.43±0.07 before treatment,and 2.35±0.90,2.35±0.87 and 0.23±0.09,0.44±0.04 after treatment;the normalized iodine concentration in arterial phase after treatment were significantly higher than those before treatment(P<0.05);however,the slope K value in the arterial and venous phases and normalized iodine concentration in venous phase after treatment showed no statistically significant differences with those before treatment(P>0.05).Before treatment,the slope K value and normalized iodine concentration in the arterial and venous phases showed no significant difference between the effective group and the ineffective group(P>0.05);after treatment,the two indexes in the arterial phase of effective group were significantly lower than those of ineffective group(P<0.05);after treatment,the two indexes in the venous phase showed no statistically significant differences between the two groups(P>0.05).Conclusion Dual-energy spectral CT quantitative analysis has certain clinical value in the evaluation of the efficacy of chemotherapy for lung adenocarcinoma,and can be used as one of the important means for the evaluation of the efficacy.