双层探测器光谱CT在肺孤立性良恶性结节中的诊断价值

Diagnostic Value of Dual-Detector Spectral CT in Solitary Benign and Malignant Pulmonary Nodules

目的 探讨双层探测器光谱CT参数在肺孤立性良恶性结节中的诊断价值。方法 2019年9月至2021年6月回顾性连续纳入孤立性肺结节58例,于手术或治疗前行双期双能CT扫描,58例肺结节均有病理结果。基于双能CT碘图和有效原子序数图,对病灶及周围肺组织进行碘浓度(IC)及有效原子序数(E-ff Z)的定量测量,IC采用标准化碘浓度(NIC)。将以上定量数据采用独立样本t检验和秩和检验,在肺良恶性两组之间进行组间比较。受试者曲线特征(ROC)评价诊断实验准确性。结果 58例肺结节中,43例恶性结节,15例良性结节。对于结节内部,动脉期NIC在两组之间差别具有统计学意义,恶性组高于良性组,静脉期NIC与平扫E-ff Z在两组间差别无统计学意义。对于良恶性结节邻近肺组织灌注的影响,动、静脉期病灶侧IC、E-ff Z及对应差值在两组间差别均有统计学意义。病灶周围肺组织灌注动脉期两侧差值曲线下面积最大。结论 光谱CT参数在肺良恶性结节鉴别诊断中有一定价值。

Objective To investigate the diagnostic value of dual detector spectral CT parameters in solitary benign and malignant pulmonary nodules. Methods From September 2019 to June 2021,58 patients with isolated pulmonary nodules were retrospectively and consecutively enrolled. Dual-phase dual-energy CT scans were performed before surgery or treatment. Pathological results were found in all 58 patients with pulmonary nodules.Quantitative measurement of iodine concentration(IC) and effective atomic number(E-FF Z) in lesions and surrounding lung tissues was carried out based on dual-energy CT iodine map and effective atomic number map. The above quantitative data were compared between benign and malignant lung groups by independent sample T-test and rank-sum test. Diagnostic accuracy was evaluated by receiver operating characteristic(ROC) analysis. Results Among 58 pulmonary nodules,43 were malignant and 15 were benign.For the inside of nodule,the difference of standardized iodine concentration in arterial phase between the two groups was statistically significant,the standardized iodine concentration in malignant group was higher than that in benign group,NIC in venous phase and plain scan E-FF Z were no statistically significant difference in between the two groups.As for the influence of pulmonary perfusion adjacent to benign and malignant nodules,IC and E-FF Z at the lesion side at the arteriovenous stage had statistical significance between the two groups,and the difference of quantitative data at the corresponding position between the lesion side and the opposite side also had statistical significance.The area under the difference curve of peripheral lung tissue was the largest during arterial perfusion. Conclusion Spectral CT parameters have certain value in differential diagnosis of benign and malignant pulmonary nodules.