双能CT基物质分析对于鉴别肺部恶性肿瘤纵隔淋巴结转移的价值

Value of dual-energy CT based material analysis in differentiating mediastinal lymph node metastasis of lung malignant tumors

目的:探讨双能CT技术标准化碘(水)浓度(NIC)、水(碘)浓度检查判断肺癌纵隔淋巴结转移的临床应用价值。方法:回顾分析58例行胸部双能CT增强扫描的肺部恶性肿瘤患者的临床及影像资料,后处理分析计算肺部恶性肿瘤以及纵隔淋巴结NIC和水(碘)浓度。将纵隔淋巴结根据手术病理结果分为淋巴结转移组和阴性组,进一步按照病理类型将转移淋巴结进行分组,比较各组间的NIC和水(碘)浓度的差异;并计算NIC、水(碘)浓度对纵隔淋巴结转移的诊断效能。结果:纵隔淋巴结阳性组47枚,NIC均值为0.18;纵隔淋巴结阴性组134枚,NIC均值0.25。肺部恶性肿瘤淋巴结转移组与阴性组间NIC及水(碘)浓度间差异具有统计学意义(P<0.01;P<0.05);肺部恶性肿瘤原发灶与纵隔淋巴结转移组间NIC值相关性具有统计学意义。不同病理类型中,仅鳞癌淋巴结转移与淋巴结阴性组间NIC及水(碘)浓度的差异具有统计学意义。鉴别鳞癌的纵隔淋巴结转移NIC为0.154,低于阈值淋巴结转移诊断敏感度、特异度分别为91.8%、66.7%;水(碘)浓度对于鉴别纵隔淋巴结效能较低。结论:采用双能CT成像进行基物质定量分析,有助于预测肺癌淋巴结转移,尤其对鳞癌有较大价值。

Objective:To evaluate the clinical value of dual-energy CT technology normalized iodine(water)concentration(NIC)and water(iodine)concentration in judging mediastinal lymph node metastasis of lung cancer.Methods:A retrospective analysis of 58 patients suffering from malignancies of lungs was performed,and the NIC and water(iodine)concentrations of mediastinal lymph nodes were obtained through enhanced dual-energy CT scan of the chest.The independent sample t test was used to compare the differences between the NIC and water(iodine)concentrations among the groups;the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of NIC and water(iodine)concentrations in judging mediastinal lymph node metastasis.Results:Among the 58 patients under surgery,47 mediastinal lymph nodes were proven pathologically to be positively metastatic(metastatic group),with a mean NIC:0.18 and 134 nodes to be negative(negative group),with a mean NIC:0.25.There were statistically significant differences in NIC and water(iodine)concentrations between the malignant tumor lymph node metastatic group and the negative group(P<0.01,P<0.05).The correlation of NIC value between the lung tumor group and mediastinal lymph node metastatic group was statistically significant.Among all pathological types,only squamous cell carcinoma lymph node metastatic group and mediastinal lymph node-negative groups had statistically significant differences in NIC and water(iodine)concentrations.The NIC for identifying squamous cell carcinoma mediastinal lymph node metastasis was 0.154,and the diagnostic sensitivity and specificity below the threshold were 91.8%and 66.7%.The water concentration is less effective in identifying mediastinal lymph nodes.Conclusion:The use of dual-energy CT imaging for quantitative analysis of basic substances is helpful to predict the lymph node metastasis of lung cancer,especially squamous cell carcinoma.