能谱CT定量参数评估非小细胞肺癌病理分化程度  

Quantitative parameters of spectral CT imaging in diagnosis of non-small cell lung cancer with different differentiation degrees

作　　者：李琦[1] 罗天友[1] 黄兴涛[2] 吴景全[1] 

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016 [2]重庆市第五人民医院放射科,重庆400062

出　　处：《中国医学影像技术》2016年第11期1678-1682,共5页Chinese Journal of Medical Imaging Technology

基　　金：临床重点专科建设项目(国卫办医涵2013544号)

摘　　要：目的探讨能谱CT定量参数在术前评估非小细胞肺癌（NSCLC）病理分化程度中的价值。方法收集67例术前接受能谱CT扫描的NSCLC患者,根据病理分化程度分为低分化组（n=32）和中高分化组（n=35）,比较2组肿瘤径线、淋巴结转移阳性率、肿瘤坏死率、远处转移阳性率及各期能谱CT定量参数,并行统计学分析。结果低分化组肿瘤径线、淋巴结转移阳性率及肿瘤坏死率均大于中高分化组,差异有统计学意义（P均〈0.05）,远处转移阳性率差异无统计学意义（P=1.000）。低分化组平扫、动脉期及静脉期能谱曲线K40-65keV、平扫有效原子序数、动脉期及静脉期碘（水）浓度均低于中高分化组,而平扫水（碘）浓度高于中高分化组,差异均有统计学意义（P均〈0.001）。平扫能谱曲线K40-65keV曲线下面积（0.802）最大,以0.67为诊断阈值,其诊断不同分化程度NSCLC的敏感度为77.1%,特异度为81.2%。结论能谱CT定量参数对评估NSCLC的分化程度有一定价值,可为术前判断肺癌病理分级提供依据。Objective To explore the value of quantitative parameters of spectral CT in the differentiation of non-small cell lung cancer（NSCLC）with different differentiation degrees before surgery.Methods Totally 67 NSCLC patients underwent chest plain and enhanced CT scan with gemstone spectral imaging（GSI）mode using spectral CT before operation.All the patients were divided into poorly differentiated group（n=32）and moderately or highly differentiated group（n=35）according to the degree of pathological differentiation.The diameters,positive rate of lymph node metastasis,tumor necrosis rate,positive rate of distant metastasis and quantitative parameters of spectral CT of the two groups were compared statistically.Results The diameters,positive rate of lymph node metastasis and tumor necrosis rate of poorly differentiated group were higher than those of moderately or highly differentiated group（all P〈0.05）,while there was no significant difference in the positive rate of distant metastasis between the two groups（P=1.000）.K40—65keVof spectral curve in unenhanced phase（UP）,arterial phase（AP）and venous phase（VP）,Eff-Z in UP and iodine concentration in AP and VP of poorly differentiated group were lower than those of moderately or highly differentiated group,while the water concentration in UP of poorly differentiated group was higher than that of moderately or highly differentiated group（all P〈0.001）.The area under curve（AUC）of K40—65keVof spectral curve in UP（0.802）was the largest.Taking 0.67 of K40—65keVof spectral curve in UP as threshold value,the sensitivity and specificity in the diagnosis of NSCLC with different differentiation degrees were 77.1%and 81.2%,respectively.Conclusion The quantitative parameters of spectral CT imaging are valuable in the differentiation of NSCLC with different differentiation degrees,and can provide some evidence for preoperative assessment of the pathological grading of lung cancer.

关 键 词：癌 非小细胞肺 分化程度 体层摄影术 X线计算机 宝石能谱成像 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]