能谱CT多参数成像鉴别孤立性肺结核与肺腺癌

Spectral CT multi-parameter imaging for differentiating solitary lesion of pulmonary tuberculosis and lung adenocarcinoma

目的观察能谱CT多参数成像鉴别孤立性肺结核(SPT)与孤立性肺腺癌(SLA)的价值。方法回顾性分析经病理证实的60例SPT(SPT组)及120例SLA(SLA组)患者的胸部能谱CT增强扫描图像,观察动、静脉期CT 70 keV单能量图像,测量病灶CT值(CT_(40 keV)、CT_(70 keV))、有效原子序数(Zeff)、碘浓度(IC)及水浓度(WC),计算能谱曲线斜率(λ_(70 keV));比较各能谱CT参数的组间差异,针对差异有统计学意义的参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估以各单一参数及联合参数鉴别SPT与SLA的效能。结果组间增强动、静脉期病灶CT_(40 keV)、CT_(70 keV)、Zeff、IC及λ_(70 keV)差异均有统计学意义(P均<0.05),WC差异均无统计学意义(P均>0.05)。增强动、静脉期各单一能谱CT参数中,CT_(40 keV)鉴别SPT与SLA的AUC分别为0.80和0.81;以增强动或静脉期各参数联合诊断的AUC分别为0.84和0.83,高于同期各单一参数(Z=1.23~5.30,P均<0.05);联合增强动、静脉期能谱CT参数的AUC为0.91,高于联合增强动或静脉期能谱CT参数的AUC(Z=-2.74、-3.46,P均<0.01),联合增强动脉期参数与联合增强静脉期参数AUC差异无统计学意义(Z=0.26,P=0.79)。结论能谱CT多参数成像可有效鉴别SPT与SLA。

Objective To investigate the value of spectral CT multi-parameter imaging for differentiating solitary pulmonary tuberculosis(SPT)and solitary lung adenocarcinoma(SLA).Methods Chest spectral CT images of 60 patients with SPT(SPT group)and 120 patients with SLA(SLA group)confirmed by pathology were retrospectively analyzed.Then 70 keV CT images in the arterial and venous phase were reviewed,CT values(CT_(40 keV),CT_(70 keV)),effective atomic number(Zeff),iodine concentration(IC)and water concentration(WC)of the lesions were measured and compared between groups,respectively,and the slope(λ_(70 keV))of the energy spectrum curve were calculated.Receiver operating characteristic(ROC)curve of parameters being significantly different between groups were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each single parameter and combining parameters for differentiating SPT and SLA.Results There were significant differences of CT_(40 keV),CT_(70 keV),Zeff,IC andλ_(70 keV)of the lesions in the arterial and venous phase between groups(all P<0.05),but not of WC(both P>0.05).Among single energy spectrum CT parameters of arterial or venous phase,AUC of CT_(40 keV)in differentiating SPT and SLA was 0.80 and 0.81,while AUC of combining arterial parameters or combining venous phase parameters was 0.84 and 0.83,respectively,higher than that of each single parameter in the same phase(Z=1.23—5.30,all P<0.05).AUC of combination of all arterial and venous phase parameters was 0.91,higher than that of combining arterial or venous phase parameters(Z=-2.74,-3.46,both P<0.01).There was no significant difference of AUC between combining arterial phase parameters and combining venous phase parameters(Z=0.26,P=0.79).Conclusion Spectral CT multi-parameter imaging could effectively differentiate SPT and SLA.