双能量CT碘图定量参数鉴别诊断鼻腔鼻窦肿块样息肉与肿瘤

目的 观察双能量CT动脉期碘图定量参数鉴别诊断鼻腔鼻窦肿块样息肉与肿瘤的价值。方法 回顾性分析80例术前接受双能量CT并经手术病理证实鼻腔鼻窦肿块患者，根据病理结果分为息肉组（n=26）、良性肿瘤组（n=24）及恶性肿瘤组（n=30）。分别测算3组病灶动脉期碘浓度（IC）、标准化碘浓度（NIC）及碘图CT值（Overlay值），比较组间参数差异；将良性肿瘤组和恶性肿瘤组合并为肿瘤组（n=54），分别绘制动脉期碘图各定量参数鉴别鼻腔鼻窦肿块样息肉与肿瘤的ROC曲线，评估其诊断效能。结果 良性肿瘤组（H=-4.13、-2.80、-4.00）和恶性肿瘤组（H=-7.02、-5.75、-6.12）动脉期IC、NIC及Overlay值均高于息肉组（P均<0.05）；恶性肿瘤组动脉期IC及NIC高于良性肿瘤组（H=-2.60、-2.73，P均<0.05），而Overlay值与良性肿瘤组差异无统计学意义（H=-1.85，P=0.20）。动脉期IC鉴别鼻腔鼻窦肿块样息肉与肿瘤的AUC（0.95）大于NIC（0.85）及Overlay值（0.91），诊断阈值取1.15 mg/ml时，诊断敏感度、特异度及约登指数分别为81.50%、96.20%及78.00%。结论 双能量CT动脉期碘图定量参数对鉴别诊断鼻腔鼻窦肿块样息肉与肿瘤具有一定应用价值。

Differential diagnosis of mass-like polyps and tumors in nasal cavity and paranasal sinus with quantitative parameters of dual-energy CT iodine map

Objective To explore the value of quantitative parameters of dual-energy CT arterial iodine map for differentiating nasal and paranasal sinus mass-like polyps from tumors. Methods Dual-energy CT data of 80 patients with nasal sinus masses confirmed by surgical pathology were retrospectively analyzed. According to pathological results, the patients were divided into polyp group (n=26), benign tumor group (n=24) and malignant tumor group (n=30). Arterial phase iodine concentration (IC), normalized iodine concentration (NIC) and iodine map CT value (Overlay value) of lesions were measured, calculated and compared among 3 groups. Then patients in benign tumor group and malignant tumor group were combined into tumor group (n=54). ROC curves of each quantitative parameters of arterial phase iodine map for differentiating nasal and paranasal mass polyps and tumors were drawn, and the relative diagnostic efficacy were evaluated. Results The arterial phase IC, NIC and Overlay value of benign tumor group (H=-4.13, -2.80, -4.00) and malignant tumor group (H=-7.02, -5.75, -6.12) were all higher than those of polyp group (all P<0.05). The arterial phase IC and NIC in malignant tumor group were higher than those in benign tumor group (H=-2.60, -2.73, both P<0.05), while Overlay value showed no statistical difference between benign and malignant tumor groups (H=-1.85, P=0.20). AUC of arterial phase IC (0.95) for differentiating nasal and paranasal mass polyps and tumors was larger than that of NIC (0.85) and Overlay value (0.91). Taken 1.15 mg/ml as the diagnostic threshold, the diagnostic sensitivity, specificity and Youden index was 81.50%, 96.20% and 78.00%, respectively. Conclusion Arterial phase iodine-related quantitative parameters of dual-energy CT have certain application value in differential diagnosis of nasal and paranasal sinus mass-like polyps and tumors.