双源双能量CT增强鉴别肺纯磨玻璃结节浸润前病变与浸润性病变  

Value of enhanced dual-source CT for differentiating pre-invasive lesion from invasive pulmonary adenocarcinoma appearing as pure ground-glass nodule

作　　者：杨杨[1] 蔡兆诚[1] 曹源[1] 孙丹丹 伍建林[1] 于晶[1] YANG Yang;CAI Zhao-cheng;CAO Yuan;SUN Dan-dan;WU Jian-lin;YU Jing(Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Liaoning 116001 China)

机构地区：[1]大连大学附属中山医院放射科,辽宁大连116001

出　　处：《影像诊断与介入放射学》2019年第2期128-133,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的利用双源双能量CT增强及轴冠矢三平面测量纯磨玻璃结节(pGGN)的定量参数,探讨其鉴别pGGN样肺浸润前病变与浸润性病变的可行性及对临床应用价值。方法收集我院经病理证实并行双源双能量CT增强扫描的32例患者共42个pGGN病灶,根据病理结果分为浸润前病变(AAH和AIS)和浸润性病变(MIA和IAC),观察与研究内容:①两组CT征象;②矢冠轴三平面测量并比较两组平均平扫CT值、平均碘含量(IC)及平均标准化碘含量(NIC);③绘制受试者工作特征(ROC)曲线,评估其诊断效能及确定两组鉴别的最佳临界值;④比较轴位与矢冠轴三平面测量两组鉴别的价值。结果①pGGN分叶征、最大径、平均平扫CT值及平均NIC对鉴别浸润前和浸润性病变差异有统计学意义(P<0.05);两组间病灶部位、毛刺征、空气支气管征或空泡征及胸膜凹陷征、平均IC差异无统计学意义(P>0.05);②最大径、平均平扫CT值及平均NIC的ROC曲线下面积分别为0.699、0.778和0.930;③矢冠轴三平面测量平均NIC较轴位测量NIC更加准确。结论双源双能量CT增强并矢冠轴三平面测量可准确测定pGGN标准化碘含量并有助于鉴别浸润前和浸润性病变,具有较好的临床应用前景。Objective To assess value of contrast-enhanced dual-source dual-energy CT (CEDECT) and three-planar measurement of pure ground glass nodules (pGGN) in differentiating pre-invasive lesion from invasive pulmonary adenocarcinoma. Methods CEDECT of 42 pGGN in 32 patients with pathologically confirmed pre-invasive lesions and invasive pulmonary adenocarcinoma was analyzed. The CT features, three-planar measurements, average unenhanced CT values, iodine concentrations (IC) and normalized iodine concentrations (NIC) of the two groups were compared using the receiver operating characteristic (ROC) curve to evaluate the diagnostic efficacy. Results There were significant differences in lobulation, maximum diameters, average unenhanced CT values, and average NIC between pre-invasive lesions and invasive pulmonary adenocarcinomas (P<0.05). There were no significant differences in lesion locations, spiculations, air bronchogram, cavitation, pleural retraction and average IC between the two groups (P>0.05). The areas under the ROC curves of maximum diameters, average unenhanced CT values and average NIC were 0.699, 0.778, and 0.930, respectively. The average NIC though three-planar measurements were more accurate than axial position measurement. Conclusion CEDECT and three-planar measurement allow accurate calculation of the NIC of pGGN, which help to differentiate pre-invasive lesion from invasive pulmonary adenocarcinoma.

关 键 词：双源双能量CT 肺腺癌 纯磨玻璃结节 增强 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]