CT能谱成像定量参数评估肺癌与肺结核球的研究进展

The Research Progress of Quantitative Parameters of Spectral CT Maging in Evaluation on Pulmonary Carcinoma and Pulmonary Tuberculoma

目的探讨能谱CT定量评估肺癌与肺结核球的价值。方法回顾性分析48例肺癌与21例肺结核球,行能谱CT两期增强扫描。测量病灶40~70kevCT值、碘浓度(IC)、水浓度(WC),计算能谱曲线斜率(K)、标准化碘浓度比(NIC)。采用独立样本t检验或Mann-WhitneyU检验,ROC曲线评估效能。Logistic回归建立联合诊断。Delong检验比较诊断效能。结果两期肺癌40~70kevCT值、K、IC、NIC均高于肺结核球(P﹤0.05)。两组两期WC差异无统计学意义(P﹥0.05)。静脉期40~70kevCT值、K、IC、NIC的AUC值均高于动脉期,其中40~50kevCT值、K及IC的诊断价值差异有统计学意义(P﹤0.05)。静脉期40kevCT值AUC(0.839)最大,取111.10HU为阈值,敏感度、特异度为81.3%、81.0%。联合静脉期40kevCT值和IC后AUC提高至0.845。结论能谱CT静脉期定量参数对肺癌与肺结核球有较高诊断价值,联合诊断可提高诊断效能。

Objective To quantitatively evaluate the value of spectral CT in pulmonary carcinoma and pulmonary tuberculoma.Method 48 cases of pulmonary carcinoma and 21 cases of pulmonary tuberculoma were retrospectively analyzed.Patients were all underwent spectral CT pulmonary enhanced dualphase CT scan.The CT values of 40~70kev and iodine(IC)and water concentration(WC)of lesions were measured,and slope of spectral curve(K)and normalized iodine concentration(NIC)was obtained.Data was analyzed statistically by independent-samples t test or Mann-Whitney U test.The diagnostic performance was evaluated using ROC analysis.Using Logistic regression model combined with the CT value of 40keV and IC.The diagnostic performance was evaluated using ROC analysis.The AUC was compared with Delong test.Result The CT value of 40~70kev,K,IC and NIC of pulmonary carcinoma in two phase were all greater than those in pulmonary tuberculoma(P﹤0.05).There was no statistically difference of WC between two groups(P﹥0.05)in two phase.The AUC values of the CT value of 40~70keV,K,IC,and NIC in VP were all greater than those in AP.The difference of CT value of 40~50ke V,K and IC was statistically significant(P﹤0.05).The CT value of 40kev in VP has the highest diagnostic performance(AUC=0.839).With cutoff value of CT value of 40kev≥111.10HU in VP,the sensitivity and specificity were 81.3%and 81.0%,respectively.After the combination of 40keV CT value and IC in VP,the AUC increased to 0.845.Conclusion Multiple quantitative parameters in VP of energy spectrum CT have higher diagnostic value for the differentiation of pulmonary carcinoma and pulmonary tuberculoma.Combined diagnosis can improve the diagnostic efficiency.