双层探测器光谱CT在肺间质性病变合并肺癌病理亚型评估的应用价值

The application value of dual-layer detector spectral CT in pathological subtypes diagnosis of interstitial lung disease with lung cancer

目的探讨双层探测器光谱CT(dual-layer detector spectral CT,DLDSCT)对肺间质性病变合并肺癌(ILD-LC)病理亚型的应用价值。方法选取行胸部DLDSCT双期增强扫描发现肺间质性病变并肺部占位的患者327例,其中经病理证实为肺癌的患者63例,由2位影像科医师独立分析患者术前CT图像,包括双肺纤维性病变的分布和程度,以及病变的形态学表现,如病变位置,有无分叶、毛刺、病变是否与纤维化交界,转移淋巴结有无融合,增强强化是否均匀、有无合并胸腔积液等;能谱数据基于静脉期增强CT图像,在碘基图上测量病变的标准化碘浓度(normal iodine concentration,NIC),采用多元logistics回归比较ILD-LC中非小细胞肺癌(NSCLC)与小细胞肺癌(SCLC)的独立预测因子;采用受试者工作特征曲线分析NIC对鉴别NSCLC与SCLC的敏感性和特异性。结果63例患者中经病理证实NSCLC 51例,SCLC 12例,不同病理亚型的肺癌中双肺间质病变程度和病变标准化碘浓度差异具有统计学意义(P<0.05);单因素分析显示ILD背景下NSCLC与SCLC有4处CT形态学差异具有统计学意义(P<0.05),当校正病灶标准化碘浓度后进行多因素分析,显示ILD-LC不同病理亚型的独立预测因子为标准化碘浓度(NIC)、肿瘤主体位置、有无淋巴结融合和病变强化是否均匀,ROC分析显示标准化碘浓度对预测ILD伴NSCLC的曲线下面积为0.82(95%CI:0.71~0.94,P=0.001),标准化碘浓度对诊断ILD-NSCLC的敏感性、特异性分别为72.5%、91.7%。结论DLDSCT能谱数据结合病变形态学表现对ILD-LC病理亚型的鉴别具有一定的应用价值,可为ILD-LC治疗提供一定参考依据。

Objective To explore the value of dual-layer detector spectral CT(DLDSCT)in pathological subtypes diagnosis of interstitial lung disease with lung cancer(ILD-LC).Methods The data of patients with lung cancer confirmed by pathology who underwent dual phase enhanced chest DLDSCT scanning in our hospital were retrospectively analyzed.A total of 63 patients who met the inclusion criteria were collected and two radiologists independently analyzed the patients'preoperative CT images,including the distribution and extent of interstitial lesions,as well as the morphological manifestations of the lesions,such as the location,the lobulation and burr sign,whether the lesions were junctional with fibrosis,whether there were fusion of lymph nodes,whether the enhancement was uniform,and whether there was combined pleural effusion.The normalized iodine concentration(NIC)of the lesion which based on venous phase were measured.The parameters with significant difference were analyzed by the Logistic regression model to differentiate SCLC from NSCLC.Receiver operator characteristic(ROC)curve was performed for NIC in venous phase to differentiate NSCLC from SCLC.Results Histology revealed NSCLC in 51 and SCLC in 12 patients.There were no statistically significant differences in the extent of interstitial lesions but the NIC between the two different pathological subtypes of ILD-LC had significant difference.In univariate analysis,4 morphological CT features differed signicantly between NSCLC and SCLC.When NIC was adjusted with CT features for multivariate analysis,the independent predictors of the two pathological subtypes were NIC,location,and fused lymph nodes and homogeneous enhancement.The area under the receiver operating characteristic curve was 0.82 for NSCLC and its sensitivity and specificity were 72.5%and 91.7%,respectively.Conclusion DLDSCT spectral data combined with morphology have certain application value in the identi-fication of pathological subtypes of ILD-LC and can provide a reference basis for treatment of ILD-LC.