能谱CT在鉴别直径≤2 cm肺炎性结节与肺癌中的价值  

The value of spectral CT imaging in differential diagnosis of pulmonary inflammatory nodules and lung cancers with a diameter ≤2 cm

作　　者：朱慧[1] 郁义星[1] Sanjeev kumar PS 包捷 王希明[1] 胡春洪[1] ZHU Hui;YU Yixing;Sanjeev kumar PS;BAO Jie;WANG Ximing;HU Chunhong(Imaging Center,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Medical Imaging,PAREXEL International Pvt Ltd,Madhapur,Hyderabad 500020,India)

机构地区：[1]苏州大学附属第一医院影像中心,江苏苏州215006 [2]Department of Medical Imaging,PAREXEL International Pvt Ltd,Madhapur, Hyderabad 500020,India

出　　处：《实用放射学杂志》2018年第11期1682-1685,共4页Journal of Practical Radiology

基　　金：苏州市临床重点病种诊疗技术专项项目（lczx201501）.

摘　　要：目的 探讨能谱CT在鉴别直径≤2 cm的肺炎性结节和肺癌中的作用。方法 回顾性分析43例经病理证实的直径≤2 cm的孤立性肺结节（SPN）患者的资料，其中炎性结节13例,肺癌30例，均已行宝石能谱成像（GSI）扫描。测量2组结节动静脉期碘浓度（IC）、40 keV和90 keV对应的CT值，计算动静脉期标准化碘浓度（NIC），动静脉期标准化碘浓度差值（ICD），动静脉期能谱曲线斜率（40~90 keV）。对2组结节的上述指标进行独立样本t检验及受试者工作特征曲线（ROC曲线）分析。结果 炎性SPN动脉期NIC（0.12±0.02）＜肺癌（0.17±0.03）（P＜0.01），炎性SPN静脉期NIC（0.46±0.02）＞肺癌（0.37±0.09）（P〈0.01）。炎性SPN ICD（0.34±0.03）＞肺癌 （0.19±0.08）（P＜0.01），NIC和ICD均有统计学意义（P＜0.01）。两者动静脉期能谱曲线斜率（λHU）均无统计学意义（P＞0.05）。鉴别两者的最佳定量参数值是ICD，其阈值0.29鉴别两者的敏感性和特异性分别为84.0%、100%。其次为动脉期NIC，其阈值0.15鉴别两者的敏感性和特异性分别为72.0%、100%。结论 能谱CT IC多参数分析对鉴别直径≤2 cm炎性SPN与肺癌的诊断价值较大，ICD和动脉期NIC具有较高的敏感度与特异度。Objective To evaluate the role of spectral CT in differential diagnosis between pulmonary inflammatory nodules and lung cancers 42 cm in diameter.Methods The imaging data of 43 patients with solitary pulmonary nodules（SPN）≤2 cm in diameter, including 13 cases with pulmonary inflammatory nodule and 30 cases with lung cancer confirmed by pathology were analyzed retrospectively. Gemstone spectral imaging （GSI） scanning was performed on all patients. The iodine concentration （IC） in arterial phase and venous phase and the CT values at 40 keV and 90 keV were measured respectively. The normalized iodine concentration （NIC）, normalized iodine concentration difference （ICD） and slope of spectral curve （40 keV-90 keV） in arterial phase and venous phase were calculated. Statistical analysis was performed by independent sample t-test, and receiver operating characteristic （ ROC） curves were established and analyzed.Results The NIC of pulmonary inflammatory nodules （0.12±0.02） in arterial phase was significantly lower than that of lung cancers （ 0.17 ± 0.03 ） （ P〈0.01 ）, while the NIC of pulmonary inflammatory nodules （ 0.46 ± 0.02 ） in venous phase was significantly higher than that of lung cancers （0.37±0.09） （P〈0.01）. Moreover, the ICD of pulmonary inflammatory nodules （0.34± 0.03） was significantly larger than that of lung cancers （0.19±0.08） （P〈0.01）. The slope of spectral curves in arterial phase and venous phase was not statistically significantly different between the two groups （P〈0.05）. Therefore,ICD was the optimal quantitative parameter for differential diagnosis and with a threshold of 0.29, and the sensitivity and specificity were 84.0 % and 100 %, respectively.NIC in arterial phase was the second best parameter for differential diagnosis, and with a threshold of 0.15, and the sensitivity and specificity were 72.0% and 100%, respectively.Conclusion Multiparameter analysis of iodine concentration by energy spectral CT bears a gre

关 键 词：孤立性肺结节 计算机体层成像 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]