能谱CT鉴别鼻腔鼻窦良恶性肿物的研究

目的探讨双源CT最佳单能量CT值及能谱曲线斜率对鼻腔鼻窦良恶性肿物的鉴别诊断价值。方法搜集60例经病理证实且直径≥1 cm的鼻腔鼻窦肿物,术前均行常规CT平扫及双能量CT双期增强扫描。根据病变的常规形态学表现判断良恶性。测量病灶实性部分的最佳CNR单能量CT值(CTose)及能谱曲线斜率(K),另测量双期融合图像病灶实性部分的CT值。根据病理结果分为良性组(34例)和恶性组(26例),评价常规形态学分析的诊断效能。比较良性组与恶性组病灶CTose值、K值、CT值,并绘制各参数的ROC曲线,比较曲线下面积(AUC),评估其诊断效能。结果常规形态学诊断的敏感性、特异性及准确性分别为61.5%、88.2%、76.7%。动脉期:良性组的CTose值、K值、CT值分别为61.91±25.62、0.92±0.69、56.56±16.67,恶性组分别为80.16±16.07、1.97±1.18、67.85±11.41;静脉期:良性组的各参数分别为68.25±26.60、1.26±0.78、62.57±19.98,恶性组分别为95.31±16.72、2.50±0.95、79.08±12.61;双期恶性组3参数均高于良性组(P值均<0.05)。动脉期病灶CTose值、K值、CT值的AUC分别为0.813、0.883、0.736,静脉期分别为0.841、0.885、0.777;其中静脉期病灶K值的AUC最大(0.885),以K=1.77为诊断阈值,其诊断敏感性、特异性及准确性分别为88.5%、88.2%、88.3%。结论双源CT的最佳单能量CT值及能谱曲线斜率可更准确地反映病变血供情况及组织差异,有助于鼻腔鼻窦良恶性肿物的鉴别诊断。

Study on the Differential Diagnosis of Benign and Malignant Tumors of the Nasal Cavity and Nasal Sinus by Energy Spectrum CT

Objective To evaluate the differential diagnosis of benign and malignant tumors of nasal cavity and nasal sinus by the optimal single energy CT value of dual source CT and the slope of the energy spectrum curve.Methods 60 cases of nasal and paranasal sinus tumors with diameter≥1 cm proved pathologically were collected.Routine CT plain scan and dual-energy CT dual-phase contrast-enhanced scanning were performed before the operation.Diagnosis of benign and malignant lesions based on the conventional morphological manifestations of the lesions.The optimal CNR single energy CT value(CTose)and the slope of energy spectrum curve(k)of the solid part of the lesion were measured.The CT value of the solid part of the lesion was measured in the dual-phase fusion image.According to the pathological results,they were divided into benign group(34 cases)and malignant group(26 cases)to evaluate the diagnostic efficacy of routine morphological analysis.The values of CTose,k and CT were compared between benign group and malignant group,and the ROC curves of each parameter were drawn.The diagnostic efficacy was evaluated by comparing the area under the curve(AUC).Results The sensitivity,specificity and accuracy of routine morphological diagnoses were 61.5%,88.2%and 76.7%,respectively.Arterial phase:the CTose value,K value,CT value of benign groups were 61.91±25.62,0.92±0.69,56.56±16.67,respectively.Those of the malignant group were 80.16±16.07,1.97±1.18,67.85±11.41,respectively.Venous phase:the CTose value,K value,CT value of benign group were 68.25±26.60,1.26±0.78,62.57±19.98,respectively.Those of the malignant group were 95.31±16.72,2.50±0.95,79.08±12.61,respectively.The parameters of the malignant group in arterial phase and venous phase were higher than those in the benign group(P<0.05).In the arterial phase:the AUC of the CTose value,K value,CT value were 0.813,0.883,0.736,respectively.Those of the venous phase were 0.841,0.885,and 0.777,respectively.Among them,the AUC of K value in the venous phase was the largest(0.885).Using K=1.77 as diagnostic threshold,the diagnostic sensitivity and specificity and accuracy were 88.5%and 88.2%and 88.3%,respectively.Conclusion The optimal single energy CT value and the slope of the energy spectrum curve of dual-source CT can more accurately reflect the blood supply and tissue difference of the lesions,which is helpful for the differential diagnosis of benign and malignant tumors of the nasal cavity and nasal sinus.