能谱CT在鉴别中央型肺癌与阻塞性肺不张中的价值研究  

Value of Spectral CT in the Differential Diagnosis of Central Lung Cancer and Obstructive Atelectasis

作　　者：傅志颖 陈亮[1] 邹南安[1] 李丰章 刘天笑 万红 FU Zhiying;CHEN Liang;ZOU Nan’an;LI Fengzhang;LIU Tianxiao;WAN Hong(Pingxiang People’s Hospital,Jiangxi Province,Pingxiang 337000,China;不详)

机构地区：[1]江西省萍乡市人民医院,江西萍乡337000

出　　处：《中国医学创新》2022年第34期122-125,共4页Medical Innovation of China

基　　金：萍乡市科技计划项目(2020PY033)。

摘　　要：目的:探究能谱CT在鉴别中央型肺癌与阻塞性肺不张中的价值。方法:选取2020年7月-2022年5月萍乡市人民医院经病理证实为中央型肺癌合并阻塞性肺不张的68例患者为研究对象,所有患者均行能谱成像模式扫描,获得常规混合能量CT动脉期图像、动脉期单能量图像及动脉期碘基图,分别观察评价常规混合能量CT动脉期图像、动脉期单能量图像对肺癌肿块与肺不张分界的正确辨别率,比较肺癌肿块与阻塞性肺不张的碘浓度(IC)、能谱衰减曲线斜率、有效原子序数(Eff-Z)。结果:常规混合能量CT动脉期图像显示68例患者均为中央型肺癌并发阻塞性肺不张,肿瘤所在位置支气管狭窄或闭塞,对应部位肺段及肺叶体积减小,肺不张位置与肿瘤区域均呈片状实性密度增高影,未能得到清晰区分;增强扫描后图像显示上瘤组织呈现轻度、中度强化,肺不张组织呈现显著均匀强化,可辨别肿瘤与肺不张组织边界共53例,正确分辨率为77.94%;动脉期单能量图像可较好清晰分辨肺癌与肺不张边界,可辨别肿瘤与肺不张组织边界共62例,正确辨别率为91.18%,动脉期单能量图像正确辨别率显著高于常规混合能量CT动脉期图像正确辨别率(χ^(2)=4.561,P=0.033);肺癌肿块的IC、衰减曲线斜率、Eff-Z均低于肺不张(P<0.05);IC、衰减曲线斜率与Eff-Z诊断鉴别中央型肺癌与阻塞性肺不张时,以衰减曲线斜率的曲线下面积(AUC)最高,敏感度、特异度分别为66.18%、86.76%,衰减曲线斜率的AUC高于Eff-Z(P<0.05),但与IC比较差异无统计学意义(P>0.05)。结论:能谱CT对于中央型肺癌与阻塞性肺不张具有较好的鉴别能力,可对肺癌诊断与治疗进行临床指导。Objective:To explore the value of spectral CT in the differential diagnosis of central lung cancer and obstructive atelectasis.Method:A total of 68 patients with central lung cancer complicated with obstructive atelectasis who were confirmed by pathology in Pingxiang People’s Hospital from July 2020 to February 2022 were selected as the research subjects.All patients underwent spectral CT.The arterial phase image of conventional mixed-energy CT,arterial phase single-energy image and iodine-based image were collected,and their accurate rates in the differential diagnosis of the borders of lung cancer mass and atelectasis were evaluated.The iodine concentration(IC),the slope of attenuation curve and effective atomic number(Eff-Z)were compared between the lung cancer mass and obstructive atelectasis.Result:Conventional mixed energy CT images in arterial phase showed that all 68 patients were central lung cancer complicated with obstructive atelectasis.Bronchial stenosis or occlusion was observed at the location of the tumor,and the corresponding lung segments and lobes were reduced in volume.The site of atelectasis and tumor area showed a patchy solid increased density,which could not be clearly differentiated.The image after enhanced scan showed that the tumor tissue showed mild and moderate enhancement,and the lung consolidation tissue showed progressive and continuous significant enhancement,which can distinguish the tumor from the parenchyma.The borders of tumor and atelectasis could be distinguished in 53 cases with correct resolution of 77.94%.Single-energy images in arterial phase could clearly distinguish the borders of lung cancer and atelectasis,the boundary between tumor and atelectasis tissue could be identified in 62 cases,and the correct identification rate was 91.18%.The correct identification rate of single-energy images in arterial phase was significantly higher than that of conventional mixed-energy CT arterial phase images(χ^(2)=4.561,P=0.033).The slope of attenuation curve and Eff-Z of lung ca

关 键 词：中央型肺癌 阻塞性肺不张 计算机体层成像 能谱 

分 类 号：R734.2[医药卫生—肿瘤] R563[医药卫生—临床医学]