【摘要】 目的探讨能谱成像鉴别诊断肺癌患者脊柱成骨性转移瘤与骨岛的价值。方法回顾性分析64例经病理证实的肺癌患者胸部或腹部能谱CT平扫图像,选择直径在0.5~1.5 cm之间的局限性椎体内高密度灶作为研究对象,由综合影像做出成骨性转移瘤或骨岛的最终诊断。分别测量椎体内局限性高密度灶的140 kVp混合能量以及50~130 keV单能量成像的CT值和SD值,以及骨(水)和水(骨)密度。应用独立样本t检验比较骨岛与成骨性转移两组各测量结果的差异,应用ROC曲线判断不同影像参数对两者的鉴别诊断效能。结果 88个局限性高密度灶纳入研究(45个成骨性转移瘤,43个骨岛)。成骨性转移瘤的混合能量和单能量的CT值、SD值均低于骨岛(P均<0.05);成骨性转移瘤的水(骨)密度高于骨岛,骨(水)密度低于骨岛(P均<0.05)。应用140 kVp及各单能量图像CT值鉴别诊断成骨性转移瘤与骨岛的ROC曲线分析显示,140 kVp图像的AUC最大、为0.741(临界CT值:734.24 HU),高keV单能量影像(110 keV,130 keV)SD值的AUC最大、均为0.873(临界SD值分别为:57.15 HU、53.71 HU),骨(水)密度、水(骨)密度的AUC均较大,分别为0.734、0.739(临界值分别为1433.30、93.99 mg/cm~3)。结论能谱CT对于鉴别成骨性转移瘤和骨岛有一定意义,高keV(110、130 keV)单能量图像上病变SD值具有最高的诊断效能。更多还原

【Abstract】 Objective To explore diagnostic value of spectral CT for the differentiation of osteoblastic metastases（OBMs） and bone islands（BIs） in patients with lung cancer.Methods In 64 patients with lung cancer undergoing spectral CT,focal hyperdense lesions on vertebral body were diagnosed as OBMs or BIs by images.ROI were placed within all lesions on traditional CT at 140 kVp and virtual monochromatic spectral（VMS） CT.The CT value and its standard deviation（SD） at 140 kVp and 50—130 keV,bone（water） and water（bone） densities[D_bone（wa） and D₍（wa）（bone）]between OBMs and BIs were compared by independent-sample t-test,and the ROC analysis was performed to compare the diagnostic efficiency for the OBMs and BIs.Results Totally 88 lesions consisting of 45 OBMs and 43 BIs were confirmed.The 140 kVp,VMS CT and SD values of the OBMs were lower than that of the BIs（all P <0.05）.The D₍（wa）（bone） of the OBMs was higher than that of BIs,and the D_bone（wa） of OBMs was lower than that of BIs（both P <0.05）.The area under curve（AUC） for CT value was 0.741 at 140 keV image（cut-off value 734.24 HU）.The AUC for SD value on high-energy VMS images（110,130 keV） were both 0.873（cut-off value 57.15 HU,53.71 HU）.And the AUC for D₍（bone（wa）） and D₍（wa）（bone） was 0.73 and0.74,respectively（cut-off value 1433.30,93.99 mg/cm3）.Conclusion Spectral CT is helpful for the differentiation of OBMs and BIs in patients with lung cancer,particularly the SD value on high-energy VMS CT image（110,130 keV）.更多还原