能谱CT参数预测肺腺癌同步脑转移的应用研究

Application on prediction of synchronous brain metastasis of lung adenocarcinoma by spectral CT parameters

目的:探讨能谱CT参数对肺腺癌同步脑转移的预测价值。方法:回顾性收集经病理证实的肺腺癌患者107例,根据头颅MRI检查结果分为脑转移组39例和未转移组68例,2组均于术前或穿刺前2周内行肺部能谱CT平扫和增强扫描,重建40、70、100 keV及碘浓度、水浓度等能谱参数,并计算能谱曲线斜率(λ_(HU))。比较2组性别、年龄、表皮生长因子受体(EGFR)基因信息等临床资料及能谱参数。结果:2组EGFR突变率比较,差异有统计学意义(P=0.003)。2组年龄和性别差异均无统计学意义(均P>0.05)。转移组40、70、100 keV的CT值及λ_(HU)和碘浓度均高于非转移组,差异均有统计学意义(均P<0.05)。2组水浓度差异无统计学意义(P=0.100)。40、70、100 keV的CT值及λ_(HU)和碘浓度的AUC分别为0.801、0.755、0.681、0.798、0.811;其中,碘浓度具有最高的诊断效能。结论:能谱CT参数对预测肺腺癌同步脑转移具有较高的临床价值,有助于临床决策的制订。

Objective:To explore the predictive value of spectral CT parameters in synchronous brain metastasis of lung adenocarcinoma.Methods:A retrospective analysis was conducted on 107 patients with lung adenocarcinoma confirmed by pathology.All patients underwent cerebral MRI scan and were divided into the brain metastasis group(39 cases)and the non-metastasis group(68 cases).All patients underwent spectral CT plain and enhancement scans with reconstruction of spectral parameters such as 40,70 and 100 keV,iodine concentration and water concentration,and the slope of the energy spectrum curve(λ_(HU))was calculated.The clinical data and spectral parameters between the two groups were compared.Results:EGFR mutation rate was statistically different between the two groups(P=0.003).There were no statistical differences in age or gender between the two groups(both P>0.05).The CT values of 40,70 and 100 keV images,λ_(HU)and iodine concentration in brain metastasis group were higher than those in the non-metastasis group(all P<0.05),while water concentration had no difference(P=0.100).The AUCs of CT values of 40,70 and 100 keV images,λ_(HU)and iodine concentration were 0.801,0.755,0.681,0.798,0.811,respectively,and iodine concentration had the highest efficiency.Conclusion:The spectral CT parameters have high clinical value in predicting synchronous brain metastasis of lung adenocarcinoma,which is helpful for clinical decision making.