CAJ | 학술논문

目的：探讨能谱 CT 在鉴别淋巴瘤、头颈部鳞状细胞癌（ SCC ）和甲状腺乳头状癌（PTC）转移淋巴结中的应用价值。方法分析2014年1月至6月非霍奇金淋巴瘤（NHL）25例共236枚淋巴结、霍奇金淋巴瘤（ HL）3例共32枚淋巴结、SCC 21例共86枚淋巴结和PTC 19例共92枚淋巴结。记录40～140 keV能量区段所对应的CT值及碘基图和水基图各枚淋巴结的碘和水含量，分别测量不同keV下淋巴结的标化CT值、标化碘含量和水含量，计算能谱曲线斜率，并进行比较分析。结果70 keV为最佳单能量图像。弥漫大B细胞型淋巴瘤（ DLBCL）、滤泡型淋巴瘤Ⅰ／Ⅱ级[ FL （Ⅰ／Ⅱ）]、T淋巴母细胞型淋巴瘤（TL-BL ）、HL、PTC和SCC转移淋巴结的标化CT值分别为0．32±0．10、0．46±0．08、0．41±0．11、0．41±0．11、0．56±0．15和0．34±0．16，标化碘含量分别为0．20±0．08、0．32±0．08、0．25±0．09、0．30±0．12、0．49±0．18和0．23±0．18，能谱曲线斜率分别为－1．92±0．55、－2．45±0．60、－1．82±0．57、－2．57±0．54、－5．44±2．41和－1．97±0．81。不同病理类型转移淋巴结标化CT值比较，除DLBCL与SCC、T-LBL与HL外，其余各类型间的差异均有统计学意义（均P＜0．05）。不同病理类型转移淋巴结标化碘含量比较，除DLBCL与SCC、FL（Ⅰ／Ⅱ）与HL、T-LBL与SCC、T-LBL与HL外，其余各类型间的差异均有统计学意义（均P＜0．05）。不同病理类型转移淋巴结能谱曲线斜率比较，除DLBCL与T-LBL、DLBCL与SCC、FL（Ⅰ／Ⅱ）与HL、T-LBL与SCC外，其余各类型间的差异均有统计学意义（均P＜0．05）。结论不同病理类型转移淋巴结的能谱CT定量参数具有一定差异，应用单能量图像CT值、碘含量及曲线斜率分析，可为淋巴结病变的诊断及鉴别诊断提供定量分析信息。
목적：탐토능보 CT 재감별림파류、두경부린상세포암（ SCC ）화갑상선유두상암（PTC）전이림파결중적응용개치。방법분석2014년1월지6월비곽기금림파류（NHL）25례공236매림파결、곽기금림파류（ HL）3례공32매림파결、SCC 21례공86매림파결화PTC 19례공92매림파결。기록40～140 keV능량구단소대응적CT치급전기도화수기도각매림파결적전화수함량，분별측량불동keV하림파결적표화CT치、표화전함량화수함량，계산능보곡선사솔，병진행비교분석。결과70 keV위최가단능량도상。미만대B세포형림파류（ DLBCL）、려포형림파류Ⅰ／Ⅱ급[ FL （Ⅰ／Ⅱ）]、T림파모세포형림파류（TL-BL ）、HL、PTC화SCC전이림파결적표화CT치분별위0．32±0．10、0．46±0．08、0．41±0．11、0．41±0．11、0．56±0．15화0．34±0．16，표화전함량분별위0．20±0．08、0．32±0．08、0．25±0．09、0．30±0．12、0．49±0．18화0．23±0．18，능보곡선사솔분별위－1．92±0．55、－2．45±0．60、－1．82±0．57、－2．57±0．54、－5．44±2．41화－1．97±0．81。불동병리류형전이림파결표화CT치비교，제DLBCL여SCC、T-LBL여HL외，기여각류형간적차이균유통계학의의（균P＜0．05）。불동병리류형전이림파결표화전함량비교，제DLBCL여SCC、FL（Ⅰ／Ⅱ）여HL、T-LBL여SCC、T-LBL여HL외，기여각류형간적차이균유통계학의의（균P＜0．05）。불동병리류형전이림파결능보곡선사솔비교，제DLBCL여T-LBL、DLBCL여SCC、FL（Ⅰ／Ⅱ）여HL、T-LBL여SCC외，기여각류형간적차이균유통계학의의（균P＜0．05）。결론불동병리류형전이림파결적능보CT정량삼수구유일정차이，응용단능량도상CT치、전함량급곡선사솔분석，가위림파결병변적진단급감별진단제공정량분석신식。
Objective To investigate the feasibility of differentiation of lymphoma, metastatic lymph nodes of squamous cell carcinoma ( SCC) and papillary thyroid carcinoma ( PTC) in the head and neck by single-source dual-energy spectral CT.Methods 25 cases of non-Hodgkin lymphoma ( NHL) with 236 lymph nodes, 3 cases of Hodgkin′s lymphoma (HL ) with 32 lymph nodes,21 cases of SCC with 86 lymph nodes and 19 cases of PTC with 92 lymph nodes were evaluated by enhanced GSIC.T attenuation of lymph nodes in the monochromatic images at different keV levels and the iodine and water contents of these lymph nodes were measured.The slope of spectral curve was calculated using CT value at 40 keVand 90 keV. All results were analyzed with ANOVA and t test.Results 70 keV had the best single energy images. Normalized Hounsfield unit ( NHU ) of diffuse large B-cell lymphoma ( DLBCL ) , follicular lymphoma (FL), T lymphoblastic lymphoma (T -LBL), HL, PTC and SCC was 0.32±0.10, 0.46±0.08, 0.41±0.11, 0.41±0.11, 0.56±0.15 and 0.34±0.16, respectively.Normalized iodine concentration (NIC) of them was 0.20±0.08, 0.32±0.08, 0.25 ±0.09, 0.30 ±0.12, 0.49 ±0.18and 0.23 ±0.18, respectively.The slope of spectral curve (k) of them was -1.92±0.55, -2.45±0.60, -1.82±0.57, -2.57±0.54, -5.44±2.41 and-1.97±0.81, respectively.Compared with the NHU , there was a statistically significant difference in each pair except DLBCL and SCC, and T-LBL and HL.Compared with the NIC, there was a statistically significant difference in each pair except DLBCL and SCC, FL and HL, T-LBL and SCC, and T-LBL and HL. Compared with the slope of spectral curve, there was statistically significant difference in each pair except DLBCL and T-LBL, DLBCL and SCC, FL and HL, and T-LBL and SCC.Conclusions Malignant lymph nodes of different types of diseases have certain different values of quantitative parameters in spectral CT imaging.By using CT attenuation, the shape and slope of spectral curve and the iodine content, single-source dual-energy CT may potentially provide a quantitative analysis tool for the diagnosis and differential diagnosis of lymph node alterations.