能谱CT鉴别诊断大肠腺癌和腺瘤的应用价值

目的:探讨能谱CT鉴别诊断大肠腺癌和腺瘤的临床应用价值。方法:回顾性分析在我院接受治疗并经病理证实的65例大肠肿瘤患者（腺癌34例，腺瘤31例）的临床资料，所有患者治疗前均接受腹部能谱CT检查，观察并记录动脉期及静脉期增强扫描的CT参数:混合能量CT值和碘（水）浓度值、40~60 keV单能量CT值和能谱曲线斜率，并应用ROC对差异显著的CT参数进行诊断效能分析。结果:腺癌在动脉期的能谱曲线斜率以及碘（水）浓度值明显高于腺瘤，差异有统计学意义（P＜0.05）；腺癌在动脉期的40 keV及50 keV单能量CT值明显高于腺瘤，差异有统计学意义（P＜0.05）；以动脉期的碘（水）浓度值对腺癌和腺瘤进行鉴别诊断时，曲线下面积（AUC）为0.835，临界值21.585 mg/cm3，敏感度79.4%，特异度90.3%。结论:能谱CT为大肠腺癌和腺瘤的鉴别诊断提供了一种全新方法，其动脉期的CT参数诊断效能较优，具有一定临床应用价值。

The value of energy spectral CT in differential diagnosis of colorectal adenocarcinoma and adenoma

Objective:To evaluate the clinical value of energy spectral CT in differential diagnosis of colorectal adenocarcinoma and adenoma.Methods:Retrospective analysis the clinical data of 65 cases of patients with colorectal tumor in our hospital for treatment,confirmed by pathology (34 cases of adenocarcinoma,31 cases of adenoma).All patients received abdominal energy spectral CT examination before treatment.Observed and recorded the CT parameters of arterial and venous phase:Mixed energy CT value,concentration of iodine (water),40~60 keV single energy CT value,slope of energy spectrum curve,and ROC was used to analyze the diagnostic effectiveness of CT parameters with significant differences.Results:The slope of energy spectrum curve and the concentration of iodine (water) of adenocarcinoma in arterial phase were significantly higher than those of adenoma,the difference were statistically significant (P＜0.05).The 40 keV and 50 keV single energy CT values of adenocarcinoma in arterial phase were significantly higher than those of adenoma,the difference were statistically significant (P＜0.05).Concentration of iodine (water) in arterial phase was used for differential diagnosis of adenocarcinoma and adenoma,area under the curve（AUC） 0.835,cut-off value 21.585 mg/cm3,sensitivity 79.4%,specificity 90.3%.Conclusion:Energy spectral CT provides a new method for differential diagnosis of colorectal adenocarcinoma and adenoma.The CT parameters in arterial phase have better diagnostic efficacy and have some clinical value.