能谱CT多参数定量分析对肺癌病理类型的鉴别诊断价值

Value of Multi-parameter Quantitative Analysis of Energy Spectrum CT in Differential Diagnosis of Pathological Types of Lung Cancer

目的分析能谱CT对肺癌病理类型的鉴别诊断价值。方法回顾性收集82例肺癌患者临床资料,所有患者均经手术病理检查确诊,将患者分为腺癌组(44例)和鳞癌组(38例),统计2组影像学特征,比较2组能谱CT多参数、动脉期、静脉期不同keV下CT值、K值,采用ROC曲线分析能谱CT多参数对肺癌病理类型的鉴别诊断价值。结果鳞癌组胸膜凹陷征、磨玻璃密度患者占比(36.84%、31.58%)低于腺癌组(65.91%、54.55%),P<0.05。鳞癌组标准化碘浓度、能谱曲线斜率、碘-水含量低于腺癌组,动脉期70、100 keV下K值高于腺癌组(P<0.05)。能谱CT多参数鉴别肺癌病理类型的敏感度比较,标准化碘浓度低于能谱曲线斜率、动脉期碘-水含量、动脉期70 keV下K值(P<0.05),能谱曲线斜率、动脉期碘-水含量、动脉期100 keV下K值低于动脉期70 keV下K值(P<0.05);特异度比较,标准化碘浓度高于能谱曲线斜率、动脉期碘-水含量、动脉期70 keV下K值、动脉期100 keV下K值(P<0.05),能谱曲线斜率高于动脉期70 keV下K值,动脉期70 keV下K值低于动脉期100 keV下K值(P<0.05);曲线下面积(AUC)比较,标准化碘浓度、动脉期70 keV下K值高于动脉期碘-水含量(P<0.05)。结论不同病理类型肺癌患者能谱CT检查胸膜凹陷征及定量参数标准化碘浓度、能谱曲线斜率、碘-水含量、动脉期、静脉期70、100 keV下K值存在明显差异,其中标准化碘浓度、能谱曲线斜率、碘-水含量、动脉期、静脉期70、100 keV下K值可有助于肺癌病理类型的鉴别诊断。

Objective To analyze the value of energy spectrum CT in differential diagnosis of pathological types of lung cancer.Methods Clinical data of 82 patients with lung cancer were retrospectively collected.All patients were confirmed by operation and pathological examination.The patients were divided into the adenocarcinoma group(44 cases)and the squamous cell carcinoma group(38 cases),and the imaging characteristics of the 2 groups were analyzed.The value of energy spectrum CT multi-parameters,CT values and K values under different keV at arterial and venous stages were compared between the 2 groups.The value of energy spectrum CT multi-parameters in the differential diagnosis of lung cancer pathological types was analyzed by ROC curve.Results The proportion of patients with pleural depression and ground glass density in squamous cell carcinoma group(36.84%,31.58%)was lower than that in adenocarcinoma group(65.91%,54.55%),P<0.05.The standardized iodine concentration,slope of energy spectrum curve and iodine-water content in squamous cell carcinoma group were lower than those in adenocarcinoma group,and the K value at arterial stage 70 and 100 keV was higher than that in adenocarcinoma group(P<0.05).Comparison of sensitivity of multi-parameter energy spectrum CT to identify pathological types of lung cancer:standardized iodine concentration was lower than the slope of energy spectrum curve,iodine-water content in arterial phase,and K value at 70 keV in arterial phase(P<0.05);slope of energy spectrum curve,iodine-water content in arterial phase,and K value at 100 keV in arterial phase were lower than K value at 70 keV in arterial phase(P<0.05).Compared with the specificity,the standardized iodine concentration was higher than the slope of the energy spectrum curve,the iodine-water content in the arterial phase,the K value at 70 keV in the arterial phase and the K value at 100 keV in the arterial phase(P<0.05),and the slope of the energy spectrum curve was higher than the K value at 70 keV in the arterial phase.The K value at 70 keV in arterial phase was lower than that at 100 keV in arterial phase(P<0.05).Compared with area under the curve(AUC),standardized iodine concentration and K value at 70 keV in arterial phase were higher than iodine-water content in arterial phase(P<0.05).Conclusion There are significant differences in the standard iodine concentration,slope of energy spectrum curve,iodine-water content,and K value at 70 keV and 100 keV in arterial and venous stages in patients with different pathological types of lung cancer.Among them,standardized iodine concentration,energy spectrum slope,iodine-water content,and K value at 70 keV and 100 keV in arterial and venous stages were helpful for differential diagnosis of pathological types of lung cancer.