IQon光谱CT在良恶性胸水鉴别诊断中的应用价值  

Application value of IQon spectral CT in differential diagnosis of benign and malignant pleural effusion

作　　者：张昌峰 乔英 ZHANG Changfeng;QIAO Ying(Shanzi Medical University,Taiyuan 030001,China;CT Room,the First Clinical Medical College of Shanzi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第一临床医学院CT室,山西太原030001

出　　处：《实用放射学杂志》2022年第8期1247-1251,共5页Journal of Practical Radiology

摘　　要：目的探讨IQon光谱CT胸膜及其周围改变定性CT征象联合胸水定量光谱参数分析在良恶性胸水鉴别诊断中的应用价值.方法回顾性分析比较105例行IQon光谱CT胸部平扫加增强扫描,且经病理和(或)临床资料明确了胸水性质的患者.定性CT征象包括弥漫性胸膜增厚、胸膜结节、胸水依赖重力分布、单侧或双侧分布、胸膜外脂肪间隙不光整以及纵隔淋巴结肿大伴不均匀强化;定量参数包括常规CT(120 kVp)图像及40 keV、70 keV虚拟单能图像胸水CT衰减值、胸水有效原子序数以及无水碘图碘浓度.首先进行单因素分析,差异有统计学意义者(P<0.05)纳入二元Logistic回归进行多因素分析.结果多因素分析显示碘浓度、胸膜结节及纵隔淋巴结肿大伴不均匀强化有统计学意义,可作为恶性胸水的独立预测因子.联合这些因素鉴别诊断时,其灵敏度、特异度及受试者工作特征(ROC)曲线的曲线下面积(AUC)分别为86.8%、84.6%、0.925[95%置信区间(CI)0.873~0.977].结论IQon光谱CT检查将定性CT征象与胸水定量光谱参数相结合时能够很好地鉴别良恶性胸水.当胸水患者出现胸膜结节、纵隔淋巴结肿大伴不均匀强化,并且胸水碘浓度>0.145 mg/mL时,需考虑恶性胸水的可能.Objective To explore the application value of IQon spectral CT in differential diagnosis of benign and malignant pleural effusion,with qualitative CT findings of pleura and its surrounding changes combined with quantitative spectral parameters of pleural effusion.Methods Chest image data of pre-and post-contrast scan with IQon spectral CT of 105 patients with pleural effusion were analyzed and compared retrospectively,and the nature of the pleural effusions were confirmed by pathology and(or)clinical data.The qualitative CT findings included dffuse pleural thickening,pleural nodule,gravity-dependent distribution of fluid,unilateral or bilateral distribution,coarse extrapleural fat space,and enlarged mediastinal lymph node with heterogeneous enhancement;Quantitative parameters included CT attenuation value of pleural effusion in conventional CT(120 kVp),40 keV and 70 keV virtual single energy imagings,effective atomic number of pleural effusion and iodine concentration in no-water iodine imagings.Firstly,univariate analysis were performed,then those factors with statistically significant differences(P<0.05)were included in the binary Logistic regression for multivariate analysis.Results Multivariate analysis showed statistically significant differences in the iodine concentration,pleural nodule and enlarged mediastinal lymph node with heterogeneous enhancement,which could be used as independent predictors of malignant pleural ffusion.By combining these factors,sensitivity,specificity and area under the curve(AUC)were respectively 86.8%,84.6% and 0.925[95% confidence interval(CI)0.873-0.977]for differentiating benign from malignant pleural effusion.Conclusion IQon spectral CT examination can well differentiate benign from malignant pleural effusion when qualitative CT findings are combined with quantitative spectral parameters of pleural effusion.The possibility of the malignant pleural effusion should be considered when pleural effusion with pleural nodule,enlarged mediastinal lymph node with heterogeneous enhance

关 键 词：IQon光谱CT 良恶性胸水 多因素分析 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563.1[医药卫生—放射医学]