CAJ | 학술논문

目的探讨能谱CT成像定量分析在鉴别诊断周围型肺癌和肺炎性肿块中的价值.方法对60例肺内孤立性肿块(周围型肺癌35例、肺炎性肿块25例)行宝石CT能谱模式(GSI)扫描,获得动脉期和静脉期的能谱系列图像.分别测量病灶中央区、周围区的碘浓度,计算其与同层面胸主动脉碘浓度的比值即标准化碘浓度(NIC),同时计算病灶中央区与周围区标准化碘浓度之差的绝对值(dNIC).自动获取能谱衰减曲线并计算其斜率(λHU).测量数据以M(Q1,Q3)表示,分别对上述参数进行2组独立样本Wilcoxon符号秩和检验,并绘制ROC曲线评估其诊断效能.结果能谱模式双期扫描周围型肺癌中央区NIC值均明显低于炎性肿块:动脉期分别为0.03(0,0.05)和0.12(0.07,0.20),静脉期分别为0.14(0.12,0.19)和0.30 (0.21,0.57),差异均有统计学意义(Z值分别为-4.14、-3.70,P值均＜0.01).而周围型肺癌dNIC值明显高于炎性肿块:动脉期分别为0.08 (0.05,0.11)和0.04(-0.02,0.08),静脉期分别为0.23(0.17,0.34)和0.07(-0.04,0.08),差异均有统计学意义(Z值分别为-2.56、-4.00,P值均＜0.05).双期扫描中周围型肺癌λHU值均低于肺炎性肿块:动脉期分别为1.03(0.67,1.67)和2.75(1.61,3.19),静脉期分别为1.58 (1.30,2.17)和3.25(2.37,4.54),差异均有统计学意义(Z值分别为-3.90、-4.42,P值均＜0.01).ROC曲线显示以静脉期λHU=2.11为阈值时,对2组病变鉴别诊断的敏感度可达89％,特异度可达91％.结论运用能谱CT成像的参数进行定量分析,对周围型肺癌和肺炎性肿块的鉴别诊断有较大价值.
목적 탐토능보CT성상정량분석재감별진단주위형폐암화폐염성종괴중적개치.방법 대60례폐내고립성종괴(주위형폐암35례、폐염성종괴25례)행보석CT능보모식(GSI)소묘,획득동맥기화정맥기적능보계렬도상.분별측량병조중앙구、주위구적전농도,계산기여동층면흉주동맥전농도적비치즉표준화전농도(NIC),동시계산병조중앙구여주위구표준화전농도지차적절대치(dNIC).자동획취능보쇠감곡선병계산기사솔(λHU).측량수거이M(Q1,Q3)표시,분별대상술삼수진행2조독립양본Wilcoxon부호질화검험,병회제ROC곡선평고기진단효능.결과 능보모식쌍기소묘주위형폐암중앙구NIC치균명현저우염성종괴:동맥기분별위0.03(0,0.05)화0.12(0.07,0.20),정맥기분별위0.14(0.12,0.19)화0.30 (0.21,0.57),차이균유통계학의의(Z치분별위-4.14、-3.70,P치균＜0.01).이주위형폐암dNIC치명현고우염성종괴:동맥기분별위0.08 (0.05,0.11)화0.04(-0.02,0.08),정맥기분별위0.23(0.17,0.34)화0.07(-0.04,0.08),차이균유통계학의의(Z치분별위-2.56、-4.00,P치균＜0.05).쌍기소묘중주위형폐암λHU치균저우폐염성종괴:동맥기분별위1.03(0.67,1.67)화2.75(1.61,3.19),정맥기분별위1.58 (1.30,2.17)화3.25(2.37,4.54),차이균유통계학의의(Z치분별위-3.90、-4.42,P치균＜0.01).ROC곡선현시이정맥기λHU=2.11위역치시,대2조병변감별진단적민감도가체89％,특이도가체91％.결론 운용능보CT성상적삼수진행정량분석,대주위형폐암화폐염성종괴적감별진단유교대개치.
Objectives To investigate the clinical significance of dual energy spectral CT (DESCT) in quantitatively differentiating peripheral lung cancers from pulmonary inflammatory masses.Methods Sixty patients with 35 lung cancers and 25 inflammatory masses underwent DESCT to get arterial phase (AP) images and venous phase (VP) images.Iodine concentrations in the central and peripheral zone of the masses were measured and normalized to the aorta as normalised iodine concentration (NIC).The difference of NIC between central and peripheral zone of the masses (dNIC) was calculated.The spectral attenuation curve was obtained automatically and the slope of curve (λHU) was also calculated in the two groups.The quantitative parameters was presented as M (Q1,Q3),and Wilcoxon signed rank test was used to compare above two independent samples.Receiver operating characteristic (ROC) curves were generated to calculate the sensitivity and specificity.Results NICs in the central zone of peripheral lung cancers were significantly lower than that of inflammatory masses:mean NICs were 0.03 (0,0.05) versus 0.12 (0.07,0.20) in AP,and 0.14 (0.12,0.19) versus 0.30 (0.21,0.57) in VP (Z=-4.14,-3.70,respectively,P＜0.01).While the dNIC values of lung cancers were significantly higher than that of inflammatory masses:dNIC values were 0.08 (0.05,0.11) versus 0.04 (-0.02,0.08) in AP,and 0.23 (0.17,0.34)versus 0.07 (-0.04,0.08) in VP(Z=-2.56,-4.00,respectively,P＜0.05).Mean λHU values of lung cancers were also lower than inflammatory masses:1.03 (0.67,1.67)versus 2.75 (1.61,3.19) in AP,and 1.58 (1.30,2.17) versus 3.25 (2.37,4.54) in VP (Z=-3.90,-4.42 respectively,P＜0.01).According to ROC curves,cutoff value of λHU =2.11 in VP had the highest sensitivity (89％) and specificity (91％) in differentiating peripheral lung cancers from inflammatory masses.Conclusions Contrast-enhanced dual energy spectral CT imaging with some quantitative parameters such as normalised iodine concentration,dNIC,and the slope of spectral attenuation curves may be a promising new method for differentiating peripheral lung cancers from inflammatory masses.