宝石能谱CT成像在鉴别不同病理类型肿瘤及其转移淋巴结中的作用

目的探讨宝石能谱CT成像在不同组织来源、病理类型肿瘤及其转移淋巴结中的鉴别诊断价值。方法回顾性分析肺癌、胃癌和食管癌患者30例，其中包括转移淋巴结41枚，行能谱cT扫描并检测肿瘤原发病灶及转移淋巴结的cT值、碘（水）基含量、有效原子序数、能谱衰减曲线及其斜率等参数。采用独立样本t检验对各组间数据进行统计学分析比较。结果除肺鳞癌转移淋巴结外，不同病理类型肺癌原发灶之间、原发灶与转移淋巴结之间以及转移淋巴结之间的主要能谱特征性参数均未见统计学差异；但它们与胃癌和食管癌转移淋巴结在中低能量区CT值、碘（水）基含量和曲线斜率皆有显著统计学差异。肺鳞癌转移淋巴结与其它肿瘤原发灶及转移淋巴结之间在中低能量区下的CT值和碘（水）基含量的差异比较皆具显著性统计学意义。结论比对分析肿瘤原发病灶及其转移淋巴结能谱CT特征参数，对不同组织来源、病理类型肿瘤及其转移淋巴结的鉴别诊断有着一定的临床指导意义。

Clinical application of gemstone spectral CT-imaging to identification and diagnosis of different pathological types of tumors and their metastatic lymph nodes

Objective To investigate the clinical value of the gemstone spectral imaging （GS1） in diagnosis of various tumors with different tissue origins and pathological features, and their respective metastatic lymph nodes. Methods 30 patients with lung, gastric or esophageal cancers （including 41 metastatic lymph nodes） underwent GSI examination. The CT values, iodine contents, effective-Z, spectral attenuation curves and curve slopes were measured. All groups were compared and independent samples t test was used for sta- tistical analysis. Results Except for metastatic lymph nodes from lung squamous cell carcinoma, there were no significant differences for the major CT parameters among tumor primary lesions of the lung cancers, between tumor primary lesions from the lung cancers and their metastatic lymph nodes, and among the metastatic lymph nodes from all the lung cancers; whereas, the CT values at low or middle keV regions, iodine contents and spectral attenuation curve slopes of the metastatic lymph nodes from gastric or esophageal cancers were of statistically significant difference compared to those of tumor primary lesions from all the lung cancers and their metastatic lymph nodes. There were significant differences in the CT values at 40 - 110 keV and iodine contents of the metastatic lymph nodes from lung squamous cell carcinoma when compared with those of the tumor primary lesions of all the cancers or the metastatic lymph nodes. Conclusion Comparative analysis of the CT parameters from tumor primary lesions and their metastatic lymph nodes has certain values in diagnosis of various tumors with different tissue .origin and pathological characteristics, as well as corresponding metastatic lymph nodes.