能谱CT在肌骨肿瘤良恶性鉴别中的价值  

The value of energy spectral CT in the differential diagnosis between benign and malignant tumor of the musculoskeletal system

作　　者：邵晓栋 刘吉华[1] 李晓飞[1] 耿青[1] 王飞飞[1] 陈海松[1] 

机构地区：[1]青岛大学医学院附属医院放射科,山东青岛266003

出　　处：《实用放射学杂志》2014年第4期638-640,共3页Journal of Practical Radiology

基　　金：山东省科技发展计划资助项目（2011YD18021）。

摘　　要：目的：通过对100例病理证实肌骨系统肿瘤所致软组织肿块的能谱CT图像分析,探讨能谱CT在肌骨系统肿瘤良恶性鉴别中的应用价值。方法对 MR扫描显示有软组织肿块的100例待手术肌骨系统肿瘤病例,进行 CT 能谱扫描及图像后处理。将感兴趣区置于软组织病变密度均匀的实性区域,避开坏死、囊变、出血及钙化区,设备自动生成 keV-CT 值曲线。根据手术病理结果,将患者分为良性组（38例）、交界组（10例）、恶性组（49例）和脂肪病组（3例）（因其曲线呈负值弓背向上形与前三者明显不同,予以单独研究）,计算每组能谱曲线平均斜率值：斜率（K）=（HU 40 keV-HU 80 keV）/40。采用Kruskal-Wallis 秩和检验进行统计学分析。结果良性组的曲线平均斜率为0.75＆#177;0.30,呈缓慢下降型,恶性组曲线平均斜率为1.64＆#177;1.00,呈速降型,交界组的斜率介于两者之间为1.34＆#177;0.45。良性组斜率小于恶性组斜率（P＜0.05）,良性组斜率小于交界性组斜率（P＜0.05）。3例脂肪瘤平均斜率为-2.00。结论能谱曲线对鉴别软组织肿块的良恶性有一定作用。负值弓背向上形曲线是含较多脂肪成分肿瘤的特征。Objective To explore the value of spectral curve in the differential diagnosis of benign and malignant tumor of the musculoskeletal system.Methods 100 patients with mass of the musculoskeletal system which were found by MRI underwent Dis-covery HD750 Gemstone CT scan ,and the images acquired were processed.Areas with homogenous density which did not contain necrosis,cyst,hemorrhage and calcification were chosen as region of interest（ROI）.The optimal Kev on single energy images was selected,then the Kev-CT curve was automatically generated.All 100 patients proved by histological examination were divided into four groups,38 cases were as group A with benign tumor,10 cases as group B with borderline tumor,49 cases as group C with ma-lignant tumor and 3 cases of lipoma（that were analyzed separately since its curve was arc shaped）.Average slope rate of every group was calculated according to the formula：K=（HU40keV-HU80keV）/40.Kruskal Wallis test was applied for statistical analysis,P value of less than 0.05 was considered statistical significant.Results The spectral curve of group C was sharply falling type with a mean slope rate of 1.64＆#177;1.00,that of group A was gradually falling type with a mean slope rate of 0.75＆#177;0.30,and that of group B was 1.34＆#177;0.45.The difference of slope rate between group A and C and between A and B were of statistical significance（P＜0.05）.The spectral curve of 3 lipomas showed arc shaped rising type with a mean slope rate of-2.00.Conclusion Spectral curve is useful in the differential diagnosis of benign and malignant tumor of the musculoskeletal system.Arc shaped curve is a specific sign for tumors containing abundant fat.

关 键 词：计算机体层成像 能谱成像 肿块 

分 类 号：R738[医药卫生—肿瘤] R814.42[医药卫生—临床医学]