宝石CT能谱成像在乳腺浸润性导管癌腋窝转移淋巴结诊断中的初步应用  

Preliminary Study of Gemstone Spectral Imaging in the Diagnosis of Axillary Lymph Nodes Metastasis in Patients with Infiltrating Ductal Breast Carcinoma

作　　者：黄丹 刘启榆 何川东[2] 周莹[2] 林华[2] 陈娇[2] 管彬[2] 王晋秋[2] 廖丽萍[2] 

机构地区：[1]西南医科大学附属医院放射科,四川泸州646000 [2]绵阳市中心医院放射科,四川绵阳621000

出　　处：《肿瘤预防与治疗》2016年第4期205-209,共5页Journal of Cancer Control And Treatment

摘　　要：目的：探讨宝石CT能谱成像（gemstone spectral imaging,GSI）在乳腺浸润性导管癌腋窝转移淋巴结诊断中的价值。方法：收集绵阳市中心医院2013年2月-2014年12月期间经病理证实并行GSI检查的乳腺浸润性导管癌患者32例,所有患者均行腋窝淋巴结清扫术。GSI扫描时间为动脉后期（33s）,图像后处理采用ADW4.6工作站及GSI-view软件。根据手术病理结果将纳入研究的淋巴结分为转移组（15枚）和非转移组（62枚）。由软件自动生成Ke V-CT值（电子千伏值-CT值）曲线,同时记录每枚淋巴结的碘基值和相应层面主动脉碘基值、不同Ke V下淋巴结CT值和相应层面主动脉的CT值。计算每枚淋巴结40-70Ke V的斜率值（斜率K=（HU40Ke V-HU70Ke V）/30）、标化碘基值（淋巴结碘基值/主动脉碘基值）、不同Ke V下的标化CT值（淋巴结CT值/主动脉CT值）。统计分析运用spss17.0。结果：在40-70Ke V区间内,转移组淋巴结与非转移组淋巴结的Ke V-CT值曲线斜率差异具有统计学意义（P〈0.05）。转移组的碘基值、标化碘基值均小于非转移组,差异有统计学意义（P〈0.05）。不同Ke V下标化CT值的差异均无统计学意义。以曲线斜率3.92作为诊断转移淋巴结的阈值时,灵敏度和特异度分别为77.4%、71.4%;以碘基值19.44作为诊断阈值时,灵敏度和特异度分别为73.3%、72.6%;以标化碘基值0.1677作为诊断阈值时,灵敏度和特异度分别为82.3%、80.0%。结论：CT能谱成像作为一种新的无创性检查方法,对诊断乳腺浸润性导管癌腋窝转移淋巴结有重要价值。Objective： To evaluate the clinical feasibility of gemstone spectral imaging（ GSI） in the diagnosis of axillary lymph nodes metastasis in patients with infiltrating ductal breast carcinoma. Methods： Thirty-two cases of pathologically proven infiltrating ductal breast carcinoma from Feb. 2013 to Dec. 2014 were included in this study. All cases underwent GSI scan in lateral artery phase（ 33s）. Images were retrospectively analyzed using GSI viewer on ADW 4. 6 work station. The axillary lymph nodes were classified as metastatic group（ n = 15） or non-metastatic group（ n = 62） according to the pathological diagnosis. The Ke V-CT value curve was generated by the computer automatically,the iodine-based value and CT value of each lymph nodes and the corresponding strata of the artery were recorded. The slope of Ke V-CT value curve [defined as： K =（ HU40 Ke V – HU70 Ke V） /30],normalized iodine-based value（ lymph node iodine-based value /arterial iodine-based value）,normalized CT values（ lymph node CT value / arterial CT value） under different Ke Vs were compared between the metastatic and non-metastatic lymph nodes. Spss17. 0 software was used for analysis and P〈0. 05 was considered statistically different. Results： The slope of Ke V-CT value curve of axillary metastatic lymph nodes was significantly different from that of non-metastatic lymph nodes（ P〈0. 05） in 40 - 70 Ke V area. The Iodine-based value and the normalized Iodine-based value of metastatic lymph nodes were significantly lower than those of the non-metastatic group（ P〈0. 05）. No statistically significant difference was found of the normalized CT value between the metastatic and non-metastatic group. When the threshold of the slope of KeV-CT value curve was set at 3. 92,the sensitivity and specificity were 77. 4% and 71. 4%,respectively. When the threshold of the Iodine-based value was set at 19. 44,the sensitivity and specificity were 73. 3% and 72. 6%,respectively. While sensitivity and specificity for the

关 键 词：能谱CT成像 乳腺浸润性导管癌 转移/非转移淋巴结 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]