宝石能谱CT成像对乳腺浸润性导管癌的诊疗价值  

Preliminary study of spectral imaging on diagnosis of infiltrating ductal breast carcinoma

作　　者：何川东[1] 黄丹[1] 刘启榆[1] 周莹[1] 林华[1] 郭仲杰[1] 管彬[1] 王晋秋[1] 廖丽萍[1] 

机构地区：[1]绵阳市中心医院放射科,四川绵阳621000

出　　处：《现代肿瘤医学》2016年第19期3124-3128,共5页Journal of Modern Oncology

基　　金：绵阳市科技攻关项目(编号:13S001-2)

摘　　要：目的：探讨宝石能谱CT成像（gemstone spectral imaging,GSI）在乳腺浸润性导管癌诊疗中的价值。方法：手术及病理证实的乳腺浸润性导管癌患者32例,共有病灶47个。由两位从事乳腺影像工作的副主任医师对图像进行盲评,分析乳腺浸润性导管癌病灶的影像特点及能谱特征。以软件自动生成的KeV-CT值曲线作为观察指标,分析浸润性导管癌病灶同正常腺体的差异。按病理结果将淋巴结分为转移组和非转移组;以淋巴结的KeV-CT值曲线斜率、碘基值以及淋巴结CT值与主动脉CT值的比值为评价指标,比较转移组淋巴结和非转移组淋巴结上述数值的差异。结果：GSI共检出44个病灶,病灶的最佳单能量图像KeV值在66-68KeV之间。碘/水（Iodine/Water）基物质图、水/脂（Water/Fat）基物质图对病灶范围、毛刺（40/44）、分叶（36/44）、钙化（11/44）、胸壁侵犯（7/44）有更清晰的显示。增强后病灶轻中度强化,CT值增加（20±6）HU。最佳单能量40KeV CTA能清晰显示肿瘤血管,以胸廓内动脉及胸外侧动脉为主（29/44）。浸润性导管癌病灶KeV-CT值曲线,与正常腺体差异明显。腋窝转移淋巴结同非转移淋巴结KeV-CT值曲线斜率在40-70KeV间差异明显,P〈0.01（t=-5.5）,差异有统计学意义。不同KeV下转移组同非转移组HU淋巴结/HU主动脉差异无统计学意义。转移组与非转移组淋巴结碘基值平均值,差异有统计学意义,P〈0.05（t=-2.1）。结论：GSI能提高小病灶及多发病灶的检出率。可以较准确地评估乳腺浸润性导管癌位置、范围、胸壁侵犯、腋窝淋巴结转移及血供情况,对乳腺浸润性导管癌的诊疗有较大的指导价值。Objective：To evaluate the clinical feasibility of Gemstone Spectral imaging in the diagnosis and treat-ment of infiltrating ductal breast carcinoma.Mehtods：All 32 cases pathologically proved with infiltrating ductal breast carcinoma underwent spectral CT scan.Images and the spectrum feature of the lesions were evaluated by two deputy chief physicians.The KeV-CT curve made by the software was used to compare the difference of infiltrating ductal breast carcinoma lesions and the normal breast tissue.The lymph nodes were classified as metastasis and non-metas-tasis by pathology.The slope of the KeV-CT curve,Iodine-water density,CT attenuation values ratio of lymph nodes and aorta （defined by the formula：CT lymph nodes/CT aorta）in ROIs were recorded.Results：The GSI had found 44 lesions.The optimal single energy of 66-68keV showed the best contrast of lesion.Material decomposition images of water（fat）and idone（water）showed the lesion extent,sub-lobe sign （40/44）spiculation （36/44）,calcification （1 1/44）,chest invasion （7/44）clearly.The lesions were mild to moderate enhanced by （20 ±6）HU.The KeV-CT curves of the tumors significantly different from the normal breast tissue.Blood supply to tumor by the internal thoracic artery and the lateral thoracic artery（29/44）can be clearly showed in the optimal monochromatic images of 40KeV. The slope of KeV -CT curve of axillary metastatic lymph nodes were significantly different from non -metastatic lymph nodes（t =-5.5,P〈0.01）.The CT attenuation values ratio of lymph nodes and aorta had no significant differences between metastasis and non-metastasis.The Iodine-water density value of metastatic lymph nodes were significantly lower than the non-metastasis（t=-2.1,P〈0.05）.Conclusion：GSI is able to improve the detectable rate of small lesions and multiple lesions.Spectral imaging of breast cancer can be evaluated by different kinds of ima-ges（including monochromatic images,material decomposition）and have great value of ac

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]