双源CT碘值及Overlay值鉴别鼻腔鼻窦软组织肿块的价值  

Preliminary study of the value of Dual-source CT iodine value and overlay value in differentiating nasal cavity and paranasal sinuses soft tissue masses

作　　者：袁欣 危春容 冯瑶杰 张梦梅 王元玲[1] 杨亚英[1] YUAN Xin;WEI Chunrong;FENG Yaojie;ZHANG Mengmei;WANG Yuanling;YANG Yaying(Department of Medical Imaging,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科

出　　处：《实用医学杂志》2019年第24期3842-3847,共6页The Journal of Practical Medicine

基　　金：云南省科技厅-昆明医科大学联合基金面上项目[编号：2017FE467(-048)]

摘　　要：目的探讨双源CT碘图中碘值及Overlay值鉴别鼻腔鼻窦软组织肿块的价值。方法收集58例经病理证实的鼻腔鼻窦软组织肿块,术前均行常规CT平扫及双能量CT双期增强扫描。在碘图中测量病灶实性部分的碘浓度(IC)及Overlay值,另测量双期融合图像病灶实性部分的CT值。根据病理结果将其分为良性组(32例)和恶性组(26例),良性组又分为血管源性肿块(7例)与非血管源性肿块(25例)。采用独立样本t检验比较良恶性组间病灶的IC、Overlay值及CT值,并对有差异的参数绘制ROC曲线,比较曲线下面积(AUC),评估其诊断效能。结果良性血管源性肿块与恶性组双期病灶的IC、Overlay值、CT值差异均无统计学意义(P=0.221、0.272、0.196、0.160、0.206、0.064);良性非血管源性肿块病灶各参数值均低于恶性组,差异均有统计学意义(均P≤0.001)。动脉期:良性非血管源性肿块的IC、Overlay值、CT值分别为(0.72±0.47)、(20.08±16.41)、(53.03±13.30),恶性组分别为(1.60±0.68)、(37.88±16.90)、(72.33±16.08);静脉期:良性非血管源性肿物各参数值分别为(0.89±0.58)、(24.98±17.22)、(58.40±17.84),恶性组分别为(1.97±0.63)、(46.80±15.02)、(82.17±13.61)。动脉期:病灶IC、Overlay值、CT值的AUC分别为0.888、0.862、0.859,静脉期分别为0.898、0.854、0.877;其中静脉期病灶IC的诊断效能最佳,以1.375 mg/mL为诊断阈值,其诊断敏感度为92.3%,特异度为88%,准确度为79.3%。结论鼻腔鼻窦良性血管源性肿块与恶性肿瘤的碘浓度、Overlay值及CT值存在重叠,诊断需结合常规形态学表现;碘浓度能更准确地反映鼻腔鼻窦肿块的血供情况,并有助于恶性肿瘤与良性非血管源性肿块的鉴别诊断。Objective To investigate the value of iodine value and overlay value of dual source CT in differentiating nasal cavity and paranasal sinuses soft tissue masses. Methods 58 cases of nasal cavity and paranasal sinus soft tissue masses diagnosed by pathology were collected. Routine plain scan and dual phase enhancement of dual energy CT were performed before operation. The iodine concentration(IC)and overlay value of the solid part of the lesion were measured by iodine imaging,and the CT value of the solid part of the lesion was measured using the dual-phase fusion image. According to the pathological results,they were divided into benign group(32 cases)and malignant group(26 cases). Benign group was divided into angiogenic masses(7 cases)and non-angiogenic masses(25 cases). The IC,overlay value and CT value of the lesions in two groups were compared using independent sample t-test. The ROC curve of each parameter were drawn,and the area under the curve(AUC)was compared to evaluate the diagnostic effectiveness. Results In arterial phase and venous phase,there was no significant difference in the IC,overlay value and CT value between benign angiogenic masses and malignant group(P > 0.05). The parameters of benign non-angiogenic masses were significantly lower than those of malignant ones(P < 0.05). Arterial phase:the IC,Overlay value and CT value of benign non-angiogenic masses were 0.72 ± 0.47,20.08 ± 16.41,53.03 ± 13.30,respectively. The malignant group were 1.60 ± 0.68,37.88 ± 16.90,72.33 ± 16.08,respectively. Venous phase:the IC,Overlay value and CT value of benign non-angiogenic masses were 0.89 ± 0.58,24.98 ± 17.22,58.40 ± 17.84,respectively. The malignant group were 1.97 ± 0.63,46.80 ± 15.02,82.17 ± 13.61,respectively. In arterial phase:the AUC of the IC,Overlay value and CT value of the lesion were 0.888,0.862,0.859,respectively. The venous phase were 0.898,0.854,0.877,respectively. Among them,the diagnostic efficiency of IC in venous phase was the best. The sensitivity,specificity and accuracy of

关 键 词：鼻腔鼻窦 体层摄影术 X线计算机 碘浓度 Overlay值 双能量CT 

分 类 号：R73[医药卫生—肿瘤]