能谱CT扫描在周围型肺癌分型中的应用

目的:探讨能谱CT不同扫描方式在周围型肺癌分型诊断的应用价值。方法:回顾性分析2018 年2 月至2018 年 10 月在山西省肿瘤医院收集的90 例经由病理证实的周围型肺癌患者的影像学资料，根据最终病理结果的不同分为肺 腺癌（ADC）、肺鳞癌（SC）、小细胞肺癌（SCLC）3 组，所有病例通过能谱CT平扫和能谱模式下的增强扫描，记录并检验 平扫形态学征象及能谱模式定量参数，通过所得征象及参数对周围型肺癌分型的结果与病理结果进行比较。结果:病 灶边缘分叶/毛刺征、支气管截断征、肿大淋巴结伴融合改变及标准化碘浓度值（NIC）、能谱曲线斜率在3 组肺癌有显 著差异（P<0.05）。组间比较结果显示边缘分叶征在SCLC与ADC组有差异；边缘毛刺征在SCLC与ADC、SC组有差 异；支气管截断征在SC与ADC、SCLC组有差异；肿大淋巴结融合在SCLC与ADC组有差异。NIC和能谱曲线斜率在 SCLC与ADC、SC组均有差异。能谱平扫和能谱模式下扫描对周围型肺癌的分型与病理结果比较显示在对ADC的灵 敏度及特异度、SCLC的灵敏度上二者有显著差异（P<0.05）。结论:ADC边缘毛刺征常见；SC边缘毛刺征、支气管截断 征常见；SCLC边缘分叶征、纵膈内淋巴结肿大伴融合改变常见。SC的NIC、能谱曲线斜率高于SCLC。ADC的NIC、 能谱曲线斜率最高；能谱模式扫描对ADC灵敏度、特异度及SCLC灵敏度高于能谱平扫扫描。

Application of energy spectrum CT scanning in the typing of peripheral lung cancer

Objective To explore the application value of different scanning modes of energy spectrum CT in the typing of peripheral lung cancer. Methods The imaging data of 90 cases of peripheral lung cancer confirmed by pathology from February 2018 to October 2018 in Shanxi Provincial Cancer Hospital were analyzed retrospectively. According to the final pathological results, the cases were classified into 3 groups, namely lung adenocarcinoma (ADC) group, squamous cell carcinoma (SC) group and smallcell lung cancer (SCLC) group. The morphological signs obtained by energy spectrum CT plain scan and the quantitative parameters obtained by enhanced scanning under energy spectrum mode were recorded. Finally, the typing results for peripheral lung cancer by the obtained signs and parameters were compared with pathological results. Results The marginal lobulation/burr sign, bronchial truncation sign, enlarged lymph nodes accompanied with fusion, normalized iodine concentration (NIC), and the slope of the spectral curve were significantly different in the 3 groups of lung cancer (P<0.05). The inter-group comparison showed that there were differences in marginal lobulation sign between SCLC group and ADC group, the marginal burr sign between SCLC group and ADC group, SC group, the bronchial truncation sign between SC group and ADC group, SCLC group, and enlarged lymph nodes accompanied with fusion between SCLC group andADC group. NIC and the slope of energy spectrum curve were different among 3 groups. The comparison between pathological results and the typing of peripheral lung cancer by energy spectrum plain scanning and enhanced scanning under energy spectrum mode shows that there were significant differences in the sensitivity and specificity toADC and the sensitivity to SCLC (P<0.05). Conclusion Marginal burr sign is common inADC marginal burr sign and bronchial truncation sign are common in SC and marginal lobulation sign and mediastinal enlarged lymph nodes accompanied with fusion are common in SCLC. The NIC and the slope of energy spectrum curve of SC are higher than those of SCLC and the NIC and the slope of energy spectrum curve of the ADC are the highest. Compared with energy spectrum plain scan, enhanced scanning under energy spectrum mode has higher sensitivity and specificity toADC and a better sensitivity to SCLC.