CT能谱成像鉴别诊断结核性与恶性胸腔积液  

Value of spectral CT imaging for identifying tuberculous and malignant pleural effusions

作　　者：杨露露[1] 潘自兵[2] 石华[1] 李丽[1] 周航[1] 刘云[2] 张志远[2] 

机构地区：[1]宁夏医科大学,宁夏银川750001 [2]宁夏医科大学附属心脑血管病医院放射科

出　　处：《实用放射学杂志》2014年第5期763-765,782,共4页Journal of Practical Radiology

摘　　要：目的：初步探讨 CT 能谱成像在鉴别结核性胸腔积液与恶性胸腔积液中的应用价值。方法回顾性分析在本院行能谱CT 扫描的经病理学确诊的胸腔积液患者67例（结核性31例,恶性36例）。应用能谱分析软件,获得2组胸腔积液各感兴趣区能谱衰减曲线图、碘（水）基图,分析其不同 keV 水平下 CT 值、有效原子序数及碘-水浓度等能谱成像定量参数的差异,根据公式：斜率=（HU40-HU90）/50计算各感兴趣区能谱曲线斜率。对2组积液的能谱特征参数进行独立样本 t 检验。结果结核性胸腔积液能谱曲线斜率（0.23±0.08）明显小于恶性胸腔积液能谱曲线斜率（0.45±0.22）,存在统计学差异（t =5.23,P =0.00〈0.05）。结核性与恶性胸腔积液有效原子序数分别为7.67±0.11和7.78±0.04,差别有统计学意义（t=5.45,P 〈0.05）。结核性与恶性胸腔积液碘（水）含量比分别为（0.19±0.07）g/L 和（0.37±0.18）g/L,差别有统计学意义（P 〈0.05）,但两者水（碘）浓度分别为（1068.27±0.01）g/L 和（1067.48±0.01）g/L,差别无统计学意义（t=0.53,P =0.60〉0.05）。结论2组胸腔积液具有不同的能谱曲线和能谱特征物质含量,CT 能谱成像为两者的鉴别诊断提供了一种可供参考的多参数影像学检查方法。Objective To evaluate the diagnostic value of dual energy spectral CT imaging in differentiating tuberculous from ma-lignant pleural effusions.Methods 67 hydrothorax patients （31 with tuberculous pleural effusions and 36 with malignant pleural effusions,confirmed pathologically）were retrospectively analyzed.They underwent plain CT with spectral imaging mode.Spectral CT parameters for the hydrothorax were obtained：effective-Z and iodine and water concentrations from the material decomposition ima-ges.Spectral HU curve （CT value as function of photon energy）was generated from the set of monochromatic images,and the slope k of the curve was further calculated as k=[HU（40 keV）-HU（90 keV）]/50.Results of the two groups were analyzed with inde-pendent sample t test.Results The slope of the spectral HU curve for malignant pleural effusions （0.45 ±0.22 ）was statistically higher than that for tuberculous pleural effusions （0.23±0.08）,（t=5.23,P 〈0.05）.The effective-Z values for tuberculous and malignant pleural effusions were （7.67±0.1 1 ）and （7.78±0.04）,respectively,with significant difference between them （t=5.45, P 〈0.05）.The iodine concentrations were （0.1 9±0.07）g/L and （0.37 ±0.18）g/L in the tuberculous pleural effusions and malig-nant pleural effusions,respectively,with significant difference （P 〈0.05）.While there was no difference for the water concentra-tions between the tuberculous pleural effusions （1 068.27±0.01）g/L and malignant pleural effusions （1 067.48±0.01）g/L,（P =0.60〉0.05）.Conclusion Spectral CT provided additional parameters than conventional CT for effectively differentiating tuberculous pleural effusions from malignant pleural effusions.Spectral CT may be used to better differentiate tuberculous pleural effusions from malignant pleural effusions .

关 键 词：胸腔积液 结核性和恶性 能谱成像 计算机体层成像 

分 类 号：R561.3[医药卫生—呼吸系统] R814.42[医药卫生—内科学]