2015 年第 2 期 第 13 卷

宝石能谱CT在提高非小细胞肺癌术前淋巴结转移状态准确性中的初步研究

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关键词：肺癌淋巴结转移计算机体层摄影

• 摘要：
• 【摘要】摘要：目的 探讨宝石能谱CT成像在提高非小细胞型肺癌（NSCLC）术前N分期准确性中应用价值的前瞻性研究。方法 收集2014年2月8日至2014年6月2日初次就诊并行胸部能谱CT增强扫描的非小细胞肺癌患者59例，并利用能谱CT后处理软件GSI Viewer对扫描所得的40keV～140keV的101幅单能量图像进行能谱分析分别。采用受试者特征曲线（ROC curve）分析获得Ratio of λHu诊断淋巴结转移的最佳临界值。结果 转移组淋巴结（31枚）能谱曲线斜率与原发灶（17灶）能谱曲线斜率之间无显著统计学差异[（1.86±0.85）vs（1.76±0.67）（P=0.627）]，未转移组淋巴结（65枚）与原发灶（42灶）能谱曲线斜率之间具有显著统计学差异[（2.09±0.77） vs （1.49±0.65），P=0.000]；转移组与未转移组的Ratio of λHU之间具有显著统计学差异[（1.05±0.26） vs （1.54±0.59），P=0.000]。经过ROC 曲线分析，确定Ratio of λHu诊断淋巴结转移的最佳临界值为1.31，该临界值的敏感性、特异性、准确性分别为64.6%、90.3%、82.0%。结论 能谱曲线分析有助于提高NSCLC术前淋巴结转移状态判定的准确性。
• Abstract: Objective The aim of this study was to prospectively evaluate the diagnostic accuracy of gemstone spectral CT in improving the diagnostic accuracy of preoperative status of lymph nodes in non-small cell lung cancer. Methods Fifty-nine consecutive patients proven NSCLC pathologically who underwent spectral CT scan were enrolled. One hundred and one sets of monochromatic images were generated ranging from 40 keV to 140 keV. All 59 cases in this group received surgical treatment, and were compared with pathological results. Draw receiver operating characteristic (ROC) curve to determine the optimal cut-off point of Ratio of λHu to improve the diagnostic value of metastatic lymph nodes. Results There was no significant difference between the λHu value of metastatic lymph nodes (n=31) and the correlative primary tumors (n=17) [(1.86±0.85) vs (1.76±0.67), P=0.627]. Statistical difference of the λHu value was shown between the non-metastatic lymph nodes (n=65) and the correlative primary tumors (n=42) [(2.09±0.77) vs (1.49±0.65), P=0.000]. Significant difference of the Ratio of λHu was shown between the metastatic and the non-metastatic lymph nodes [(1.05±0.26) vs (1.54±0.59), P=0.000]. The cut-off point of Ratio of λHu in assessment of metastatic lymph nodes was 1.31 determined by ROC curve method . Thus, the sensitivity, specificity, accuracy value were 64.6%、90.3%、82.0% respectively. Conclusion Spectral Hu curve analysis on gemstone spectral CT is proved to be helpful in improving the diagnostic accuracy of preoperative status of lymph nodes in non-small cell lung cancer.