双层探测器光谱CT单能量图像及电子云密度图鉴别诊断肺磨玻璃结节良性与恶性的价值  

The value of virtual monoenergetic images and electron density map derived from dual-layer spectral detector CT in differentiating benign from malignant pulmonary ground glass nodules

作　　者：邱建升 辛小燕[2] 杨雯 储晨 陈杏彪 盛志洪 李宝新 张鑫 傅晓明 张冰[1] Qiu Jiansheng;Xin Xiaoyan;Yang Wen;Chu Chen;Chen Xingbiao;Sheng Zhihong;Li Baoxin;Zhang Xin;Fu Xiaoming;Zhang Bing(Gulou Clinical Medical College of Nanjing Medical University,Nanjing 210008,China;Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Clinical Science,Philips Healthcare,Shanghai 200070,China;Department of Medical Imaging,Nanjing Gaochun People′s Hospital,Nanjing 211300,China)

机构地区：[1]南京医科大学鼓楼临床医学院,南京210008 [2]南京大学医学院附属鼓楼医院医学影像科,南京210008 [3]飞利浦临床科研部,上海200070 [4]南京市高淳人民医院医学影像科,南京211300

出　　处：《中华放射学杂志》2022年第2期175-181,共7页Chinese Journal of Radiology

摘　　要：目的探讨双层探测器光谱CT单能量图像(VMI)及电子云密度图(EDM)在肺磨玻璃结节(GGN)良性与恶性鉴别诊断中的价值。方法回顾性分析2019年7月至2020年8月南京医科大学鼓楼医学院经病理证实的65例GGN患者影像资料。65例中,良性27例、恶性38例,均于术前2周内接受双层探测器光谱CT扫描,并在后处理工作站重建出常规120 kVp混合能量图像(PI)、电子云密度图及40~80 keV虚拟单能量图。采用Mann-Whitney U检验比较良性与恶性GGN在PI、40~80 keV VMI中的CT值及电子云密度(ED);采用独立样本t检验比较良性与恶性GGN的大小;采用χ^(2)检验分析并比较良性与恶性GGN的CT征象,包括病灶大小、部位、形态、边缘、内部结构、邻近结构、结节类型等。采用受试者操作特征(ROC)曲线分析不同能谱定量参数对良性与恶性GGN的鉴别诊断效能。将差异有统计学意义的CT征象及各能谱定量参数采用logistic回归进行多因素分析,找出预测GGN为恶性病变的独立危险因素,然后将各独立危险因素单独或联合行ROC曲线分析。结果病灶形态、毛刺、分叶、部位、大小在肺良性与恶性GGN间差异有统计学意义(P<0.05)。良性与恶性GGN的PI、40~80 keV VMI中CT值及EDM中的ED值差异均有统计学意义(P<0.05)。PI、40~80 keV VMI中CT值及EDM中的ED值鉴别诊断良性与恶性GGN的ROC曲线下面积(AUC)分别为0.680、0.682、0.683、0.686、0.694、0.676、0.722,其中ED值的AUC最高。以GGN形态、毛刺、分叶、部位、大小、ED值及PI、40~80 keV VMI中CT值为自变量,GGN为恶性或良性为因变量进行二元logistic回归分析,结果显示ED值(OR=1.045,95%CI 1.001~1.090,P=0.044)、病灶大小(OR=1.582,95%CI 1.159~2.158,P=0.004)、毛刺征(OR=11.352,95%CI 2.379~54.172,P=0.002)均为恶性GGN的独立危险因素。对ED值、病灶大小、毛刺征单独及三者联合进行ROC曲线分析,鉴别诊断GGN良性与恶性的AUC为0.722、0.772、0.698�Objective To investigate the clinical value of virtual monoenergetic images(VMI)and electron density map(EDM)derived from the dual-layer spectral detector CT(DLCT)in the differential diagnosis of benign and malignant pulmonary ground glass nodules(GGN).Methods From July 2019 to August 2020,a total of 65 patients with lung GGN(27 benign GGNs and 38 malignant GGNs)confirmed by pathology were retrospectively enrolled in Gulou Clinical Medical College of Nanjing Medical University.All the patients underwent DLCT plain scanning within two weeks before the surgery.The conventional 120 kVp polyenergetic image(PI),EDM and 40-80 keV VMI were reconstructed.The differences of CT and electron density(ED)values between benign and malignant lesions on different images were compared by Mann-Whitney U test.Independent t-test was used to compare the lesion size andχ^(2) test was used to analyze the CT features(including lesion location,shape,edge,internal structure,adjacent structure,nodule type)between benign and malignant lesions.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of different energy spectrum quantitative parameters in the differential diagnosis of benign and malignant GGN.The statistically significant CT signs and energy spectrum quantitative parameters were analyzed by logistic regression analysis to find out the independent risk factors of malignant GGN,and then ROC curve analysis was performed for each independent risk factor alone or in combination.Results There were significant differences in lesion shape,spiculation,lobulation,location and size between benign and malignant groups(P<0.05).The CT value of pulmonary GGN in PI,40-80 keV VMI and the ED value in EDM were statistically different between benign and malignant lesions(P<0.05).The area under ROC curve(AUC)were 0.680,0.682,0.683,0.686,0.694,0.676 and 0.722,respectively,among which the ED value had the highest AUC.Binary logistic regression analysis was carried out with GGN shape,spiculation,lobulation,location,size,ED value

关 键 词：肺肿瘤 肺磨玻璃结节 体层摄影术 X线计算机 电子云密度 

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