Relationship between quantitative parameters of dual- layer detector spectral CT and lung cancer and its pathological characteristics
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摘要:
目的 分析双层探测器光谱CT定量参数与肺癌及其病理特征的关系。 方法 收集2021年3月~2022年1月共87例肺癌患者的临床资料纳入肺癌组，并选择同期入院治疗的36例肺炎性结节患者作为对照组，两组患者治疗前2周内均行双层探测器光谱CT扫描。比较两组常规CT参数及光谱CT定量参数差异，并分析肺癌组不同病理特征者光谱CT定量参数差异。 结果 两组棘突征、CT值及动脉期碘密度(IC)、标准化IC(NIC)、有效原子序列(Zeff)比较，差异无统计学意义(P > 0.05)，肺癌组分叶征、毛刺征、胸膜凹陷征及血管集束征CT征象多于对照组(P < 0.05)，肺癌组静脉期IC、NIC及Zeff均低于对照组(P < 0.05)。肺癌组不同病理特征者动脉期IC、NIC、Zeff的差异无统计学意义(P > 0.05)，腺癌者静脉期IC、NIC及Zeff高于鳞癌及小细胞癌者(P < 0.05)，鳞癌者则高于小细胞癌者(P < 0.05)。 结论 双层探测器光谱CT定量参数对鉴别肺癌与肺炎性结节有利，且能辅助判断肺癌病理特征，具有良好应用前景。 Abstract:Objective To analyze the relationship between dual-layer detector spectral CT quantitative parameters and lung cancer and its pathological characteristics. Methods The clinical data of 87 patients with lung cancer (lung cancer group) were collected from March 2021 to January 2022. Thirty-six patients with lung inflammatory nodules who were admitted to the hospital during the same period were included in control group. All patients in the two groups received dual-layer detector spectral CT within 2 weeks before treatment. The differences in conventional CT parameters and spectral CT quantitative parameters were compared between the two groups. The differences in spectral CT quantitative parameters were analyzed among patients in lung cancer group with different pathological characteristics. Results There were no statistical differences in the spinous process sign, CT value and iodine content (IC)、normalized IC (NIC), effective atomic number (Zeff) in the arterial phase between the two groups (P > 0.05). But the CT signs of lobulation sign, spiculation sign, pleural indentation and vessel convergence sign in lung cancer group were more than those in control group (P < 0.05). The IC, NIC and Zeff in the venous phase were lower in lung cancer group than those in control group (P < 0.05). There were no statistical differences in the IC, NIC and Zeff in the arterial phase among patients with different pathological characteristics in lung cancer group (P > 0.05). The IC, NIC and Zeff in the venous phase of adenocarcinoma were higher than those of squamous cell carcinoma and small cell carcinoma (P < 0.05). The three indicators of squamous cell carcinoma were higher than those of small cell carcinoma (P < 0.05). Conclusion The quantitative parameters of dual-layer detector spectral CT are beneficial to distinguishing lung cancer from lung inflammatory nodules. It can assist in judging the pathological characteristics of lung cancer, with a good application prospect. -
Key words:
- lung cancer /
- lung inflammatory nodules /
- spectral CT /
- dual-layer detector
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图 1 肺腺癌Ⅳ期患者光谱CT图像
A: CT平扫图像, 右肺下叶近肺门处见80 mm×49 mm不规则软组织肿块, 右肺下叶部分支气管局部狭窄闭塞, 部分肺组织不张, 相邻胸膜被牵连; B~D: 分别为动脉期图像、静脉期图像、延迟期图像, 病灶呈不均匀轻-中度进行性强化, 灶内见低密度坏死区, 邻近部分肺动、静脉显示不清.
Figure 1. Spectral CT imagings of patients with stage IV lung adenocarcinoma.
图 2 肺鳞癌Ⅳ期患者光谱CT图像
A: CT平扫图像，右肺上叶见一85 mm×71 mm不规则肿块, 邻近胸膜稍示增厚, 边缘见分叶及毛刺征, 内密度欠均匀，右肺上叶支气管狭窄截断; B~D: 分别为动脉期图像、静脉期图像、延迟期图像, 肿块呈不均匀中度延迟强化, 灶内见无强化低密度坏死区, 动脉期灶内见多发增粗迂曲血管影, 右肺上叶部分动、静脉局部受侵.
Figure 2. Spectral CT imagings of patients with stage IV squamous cell lung carcinoma.
图 3 肺小细胞癌Ⅳ期患者光谱CT图像
A: CT平扫图像, 右肺下叶见一48 mm×32 mm软组织团块, 内见低密度坏死区, 边缘见浅分叶, 未见毛刺, 与相邻胸膜分界不清; B~D: 分别为动脉期图像、静脉期图像、延迟期图像, 病灶呈轻度不均匀延迟强化, 测三期CT值约64.4 Hu、76.9 Hu、79.0 Hu.
Figure 3. Spectral CT imagings of patients with stage IV small cell lung cancer.
表 1 两组常规CT参数比较
Table 1. Comparison of conventional CT parameters between the two groups [n(%)]
组别 分叶征 毛刺征 胸膜凹陷征 血管集束征 棘突征 CT值(Hu, Mean±SD) 平扫 动脉期 静脉期 肺癌组(n=87) 52(59.77) 49(56.32) 55(63.22) 48(55.17) 45(51.72) 43.56±8.06 61.99±12.27 87.43±16.95 对照组(n=36) 12(33.33) 10(27.78) 14(38.89) 11(30.56) 15(41.67) 44.69±7.35 66.07±13.44 94.05±18.22 χ2/t 7.130 8.312 6.120 6.182 1.031 0.725 1.631 1.928 P 0.008 0.004 0.013 0.013 0.310 0.470 0.105 0.056 
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表 2 两组光谱CT定量参数比较
Table 2. Comparison of quantitative parameters of spectral CT between the two groups (Mean±SD)
组别 IC(mg/mL) NIC Zeff 动脉期 静脉期 动脉期 静脉期 动脉期 静脉期 肺癌组(n=87) 1.31±0.24 2.09±0.22 0.13±0.03 0.41±0.05 8.09±0.16 8.23±0.15 对照组(n=36) 1.39±0.27 2.31±0.35 0.14±0.04 0.47±0.06 8.14±0.17 8.44±0.17 t 1.621 4.201 1.520 5.703 1.548 6.791 P 0.108 < 0.001 0.131 < 0.001 0.124 < 0.001 IC: 碘密度; NIC: 标准化碘密度; Zeff: 有效原子序列.
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表 3 肺癌组不同病理特征者光谱CT定量参数比较
Table 3. Comparison of spectral CT quantitative parameters of patients with different pathological characteristics in lung cancer group (Mean±SD)
组别 IC(mg/mL) NIC Zeff 动脉期 静脉期 动脉期 静脉期 动脉期 静脉期 腺癌(n=48) 1.33±0.25 2.17±0.23 0.13±0.03 0.43±0.04 8.12±0.17 8.33±0.16 鳞癌(n=24) 1.30±0.22 2.04±0.22a 0.13±0.04 0.40±0.06a 8.08±0.16 8.14±0.15a 小细胞癌(n=15) 1.25±0.20 1.90±0.18ab 0.12±0.03 0.35±0.05ab 8.02±0.15 8.03±0.13ab F 0.685 9.411 0.569 16.370 2.206 27.311 P 0.507 < 0.001 0.568 < 0.001 0.116 < 0.001
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