CT能谱曲线评估恶性孤立性肺结节分化程度的可行性研究

发布时间：2018-12-09 14:30

【摘要】：目的:尽管孤立性肺结节(SPN)的术前检出率较高,分化程度的鉴别仍较为困难,本研究主要目的为评估CT能谱曲线在SPN分化程度鉴别诊断中的应用价值,为临床进一步应用该技术提供依据。资料与方法:收集37例(本院及13家分中心医院)接受CT能谱成像双增强扫描的SPN患者,所有患者均经病理证实且未经治疗,根据病理分化程度分为低、中、高分化三组。所有数据传送至GE AW 4.6后处理站,通过GSI Viewer后处理软件获得病灶的能谱衰减特征曲线。根据病灶在40ke V、80ke V及140ke V动脉期及静脉期的单能量CT值,计算并比较不同能量节段内能谱衰减特征曲线斜率的绝对值,同时采用ROC曲线评估不同能量节段内能谱衰减特征曲线斜率的诊断效能,并计算诊断敏感性及特异性。结果:所有37例患者中,低分化型18例,中分化型13例,高分化型6例。病灶的单能量CT值随着X线能量水平的降低表现趋势相似,均为下降型即衰减特征曲线的斜率为负数。随着单能量ke V值的逐渐降低,相应的衰减特征曲线走形略低平;而当单能量ke V值增高时,相应的衰减特征曲线走形越陡。低分化SPN仅在40~80ke V能量节段内能谱衰减特征曲线斜率,与中分化SPN和高分化SPN的能谱衰减特征曲线斜率存在统计学意义(P0.05)。与高能量节段的病灶衰减特征曲线走形相比,低能量节段内病灶的衰减特征曲线斜率差异较动脉期稍大,差异有统计学意义(P0.05),且在40~80ke V能量节段内差异最为明显(P0.05)。40~80ke V能量节段内能谱衰减特征曲线斜率在鉴别不同分化程度SPN中的诊断效能,动脉期各组间选择最佳阈值后的诊断敏感度及特异度分别可达80%以上,静脉期选择最佳阈值后的诊断敏感度及特异度分别可达70%以上。结论:不同分化程度SPN的能谱衰减特征曲线斜率存在差异,其对于恶性SPN治疗方案的选择及预后的判断有一定的参考价值。
[Abstract]:Objective: although the detection rate of solitary pulmonary nodules (SPN) was high before operation, it was still difficult to differentiate the degree of differentiation. The purpose of this study was to evaluate the value of CT energy spectrum in differential diagnosis of SPN differentiation. To provide the basis for clinical application of this technique. Materials and methods: a total of 37 patients with SPN underwent dual enhanced CT energy dispersive imaging were collected. All patients were pathologically confirmed and untreated. According to the degree of pathological differentiation, they were divided into three groups: low, middle and highly differentiated. All the data were transmitted to the GE AW 4.6 post processing station, and the characteristic curve of energy spectrum attenuation of the lesion was obtained by GSI Viewer post processing software. According to the single energy CT values of the lesions in the arterial and venous phases of 40ke V and 140ke V, the absolute slope of the characteristic curve of energy spectrum attenuation in different energy segments was calculated and compared. At the same time, the ROC curve was used to evaluate the diagnostic efficiency of the slope of the characteristic curve of energy spectrum attenuation in different energy segments, and the diagnostic sensitivity and specificity were calculated. Results: among the 37 patients, there were 18 cases of low differentiation type, 13 cases of medium differentiation type and 6 cases of high differentiation type. The single energy CT value of the lesion showed a similar trend with the decrease of X-ray energy level, and the slope of the attenuation characteristic curve was negative. With the decrease of ke V value of single energy, the profile of the corresponding attenuation characteristic curve is slightly lower, but when the value of single energy ke V increases, the corresponding attenuation characteristic curve becomes steeper. The slope of energy spectrum attenuation characteristic curve of low differentiation SPN was only in the energy segment of 40~80ke V, which was significantly higher than that of moderately differentiated SPN and highly differentiated SPN (P0.05). Compared with the curve of attenuation characteristic curve of high energy segment, the slope of attenuation characteristic curve of low energy segment was slightly larger than that of arterial phase (P0.05). The difference was most obvious in the 40~80ke V segment (P0.05). The slope of the characteristic curve of energy spectrum attenuation in the 40~80ke V segment was used to differentiate the SPN with different differentiation degree. The diagnostic sensitivity and specificity of each group were above 80% after selecting the best threshold in arterial phase, and the diagnostic sensitivity and specificity were more than 70% after selecting the best threshold in venous phase. Conclusion: there are differences in the slope of the characteristic curve of energy spectrum attenuation of SPN with different differentiation degrees, which has certain reference value for the choice of therapeutic regimen and the judgement of prognosis for malignant SPN.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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