能谱CT对cT_(1-2)N_(0)M_(0)期周围型肺腺癌淋巴结转移诊断价值  

DIAGNOSTIC VALUE OF SPECTRAL COMPUTED TOMOGRAPHY FOR LYMPH NODE METASTASIS IN cT_(1-2)N_(0)M_(0)PERIP-HERAL LUNG ADENOCARCINOMA

作　　者：杨锴 张亮[1] 徐凤磊[1] 娄和南 林吉征[1] YANG Kai;ZHANG Liang;XU Fenglei;LOU Henan;LIN Jizheng(Department of Radiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院放射科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2023年第6期907-912,共6页Journal of Qingdao University(Medical Sciences)

基　　金：吴阶平医学基金资助项目(320.6750.17558)。

摘　　要：目的探讨能谱CT成像在术前预测cT_(1~2)N_(0)M_(0)期周围型肺腺癌淋巴结转移的价值。方法前瞻性选取67例经术后病理证实的cT_(1~2)N_(0)M_(0)期周围型肺腺癌病人作为研究对象,所有病人术前均进行双期能谱CT增强扫描,术中行肺叶切除及系统性淋巴结清扫。能谱CT参数包括肿瘤原发灶动静脉期40~100 keV单能量CT值、碘浓度(IC)、水浓度(WC)、标准化碘浓度(NIC)、标准化水浓度(NWC)、标化有效原子序数(Neff-Z)、40~100 keV能谱曲线斜率(λHu)。比较淋巴结有转移组和无转移组的临床特征、影像特征及能谱CT参数,对差异有统计学意义的参数采用受试者工作特征(ROC)曲线分析评价诊断效能。结果两组临床特征和常规CT特征差异均无统计学意义(P>0.05);有转移组动静脉期的λHu、IC、NIC显著低于无转移组(t=2.020~4.115,P<0.05),动脉期的Neff-Z显著低于无转移组(Z=2.307,P<0.05)。ROC曲线分析结果显示,动脉期能谱CT参数中λHu、IC、NIC、Neff-Z的曲线下面积(AUC)分别为0.67、0.72、0.85、0.70,静脉期能谱CT参数中λHu、IC、NIC的AUC分别为0.69、0.71、0.74。结论能谱CT参数对术前预测cT_(1~2)N_(0)M_(0)期周围型肺腺癌淋巴结转移具有一定的定性评估价值,有利于早期判断N分期,辅助临床决策。Objective To explore the value of spectral computed tomography(CT)in predicting lymph node metastasis in cT_(1-2)N_(0)M_(0)peripheral lung adenocarcinoma prior to surgery.Methods We prospectively included 67 patients with cT_(1-2)N_(0)M_(0)0 peripheral lung adenocarcinoma confirmed by postoperative pathology.All the patients were examined by dual-phase enhanced spectral CT scanning before pulmonary lobectomy with systematic lymph node dissection.Spectral CT parameters inclu-ded the CT values at 40-100 keV,iodine concentration(IC),water concentration,normalized iodine concentration(NIC),normalized water concentration,normalized effective atomic number(Neff-Z),and the slope of 40-100 keV spectral curve(λHu)in the arterial and venous phases at primary tumor sites.The clinical features,radiologic features,and spectral parameters were compared between the patients with and without lymph node metastasis.The significant parameters were evaluated for diagnostic performance by using a receiver operating characteristic(ROC)curve.Results There were no significant differences in clinical features and conventional CT features between the metastasis group and non-metastasis group(P>0.05).The metastasis group showed significantly lowerλHu,IC,NIC in the arterial and venous phases(t=2.020-4.115,P<0.05)and significantly lower Neff-Z in the arterial phase compared with the non-metastasis group(Z=2.307,P<0.05).The ROC curve analysis showed that the areas under the curves of arterial-phaseλHu,IC,NIC,and Neff-Z were 0.67,0.72,0.85,and 0.70,respectively;those of venous-phaseλHu,IC,and NIC were 0.69,0.71,and 0.74,respectively.Conclusion The spectral CT parameters have moderate qualitative value for preoperative prediction of lymph node metastasis in cT_(1-2)N_(0)M_(0)peripheral lung adenocarcinoma,which is helpful for early N staging and clinical decision.

关 键 词：周围型肺腺癌 淋巴结转移 能谱CT 定性诊断 

分 类 号：R445.3[医药卫生—影像医学与核医学]