能谱CT对喉和下咽鳞癌颈部淋巴结转移诊断价值的研究

Spectral CT imaging in the evaluation of status of lymph nodes in laryngeal and hypopharyngeal squamous cell carcinoma

目的评价能谱CT参数对喉和下咽鳞癌(laryngeal and hypopharyngeal squamous cell carcinoma, LHSCC)转移淋巴结与非转移淋巴结鉴别诊断的价值。方法搜集经病理证实的73例LHSCC患者(转移组42例,非转移组31例),所有患者治疗前均行能谱CT扫描,对转移组与非转移组原发灶及淋巴结的能谱曲线斜率及斜率比值进行分析比较。结果转移组淋巴结(42枚)与非转移组淋巴结(31枚)的能谱曲线斜率分别为2.5±0.7和2.1±0.7,差异具有统计学意义(P=0.037);转移组原发灶(42灶)与非转移组原发灶(31灶)的能谱曲线斜率差异无统计学意义(P=0.177);转移组与非转移组的斜率比值分别为1.09±0.38和0.81±0.25,差异具有非常显著的统计学意义(P=0.001)。ROC曲线分析,以斜率比值0.86为阈值诊断淋巴结转移的曲线下面积(AUC)、敏感度和特异度分别为0.773、83.3%和77.4%。结论能谱CT参数有助于喉和下咽鳞癌转移淋巴结与非转移淋巴结的鉴别诊断。

Objective To evaluate the value of spectral CT parameters in differential diagnosis of metastatic lymph nodes and non-metastatic lymph nodes in laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC). Methods Seventy-three patients with pathologically proven LHSCC(42 cases of metastatic group and 31 cases of non-metastatic group) underwent contrast-enhanced energy spectral scan. The λHu-P, λHu-L, and λHu were compared between metastatic and non-metastatic groups. Results The λHu-L was(2.5±0.7) and(2.1±0.7), respectively, and the difference was statistically significant(P=0.037). No significance of λHu-P was observed between metastatic and non-metastatic groups(P=0.177). The λHu were(1.09±0.38) and(0.81±0.25), respectively, and the difference was statistically significant(P=0.001). Setting λHu value of 0.86 as threshold to distinguish metastatic and non-metastatic lymph nodes, the AUC, sensitivity and specificity were 0.773, 83.3%, 77.4%, respectively. Conclusion Spectral CT parameters might contribute to the differential diagnosis of cervical lymph nodes in LHSCC.