双能量CT多参数碘定量术前诊断肺癌亚型的研究

目的评估双能量CT(DECT)多参数碘定量在术前区分肺癌亚型的能力。方法86例经病理证实为肺鳞癌(n=27)、腺癌(n=59)患者接受了胸部对比增强双期双能量CT扫描纳入研究。比较肿瘤DECT参数、虚拟平扫值(VNC)、碘增加值(OVERLAY)、碘浓度(IC)及三维碘值(3D-IRA),分别经正态性检验,对正态分布参数采用t检验,否则采用非参检验;用曲线下面积(AUC)来表示各参数的诊断效能,并计算出相应参数鉴别两种肺癌的敏感度、特异度,通过约登指数确定最佳阈值。结果定量分析显示,肺腺癌患者的OVERLAYAP、OVERLAYVP、ICAP、ICVP、3D-IRAVP及3D-IRAAP值均显著大于肺鳞癌(P<0.05)。在33.95 HU的临界值(阈值)下,3D-IRAVP值在区分肺鳞癌、肺腺癌的曲线下面积为0.771,敏感性为80.0%,特异性为76.5%,表现最高。结论使用DECT多参数进行碘定量可能有助于术前区分肺鳞癌和肺腺癌。

Objective To evaluate the ability of dual energy CT(DECT)multiparameter iodine quantification in preoperative differentiation of lung cancer subtypes.Methods 86 patients with lung squamous cell carcinoma(n=27)and adenocarcinoma(n=59)confirmed by pathology underwent chest contrast-enhanced DECT scanning and were included in the study.The tumor DECT parameters,virtual plain scan value(VNC),iodine added value(OVERLAY),iodine concentration(IC)and three-dimensional iodine value(3D-IRA)were compared.The CT quantitative iodine parameters that met the normal distribution were compared by two independent sample t-test,and those who did not meet the normal distribution were compared by rank sum test.The correlation analysis was carried out for the two-dimensional and three-dimensional quantitative iodine parameters with statistical difference.The ROC curve was drawn for the parameters with statistically significant difference.The area under the curve(AUC)was used to represent the differential diagnostic efficacy of each parameter,and the sensitivity and specificity of the corresponding parameters in differentiating lung squamous cell carcinoma and adenocarcinoma were calculated.The optimal threshold was determined by Yoden index.Results Quantitative analysis showed that the values of OVERLAYAP,OVERLAYVP,ICAP,ICVP,3D-IRAAP and 3D-IRAVP in lung adenocarcinoma patients were significantly higher than those in lung squamous cell carcinoma(P<0.05).At the critical value(threshold)of 33.95 HU,the AUC of 3D-IRAVP in distinguishing lung squamous cell carcinoma from lung adenocarcinoma was 0.771,the sensitivity and the specificity were 80.0% and 76.5%,showing the highest performance.Conclusion Iodine quantification using DECT multiple parameters may be helpful to distinguish lung squamous cell carcinoma from lung adenocarcinoma.