【作者】 张楠；

【导师】 乔英；

【作者基本信息】 山西医科大学 ， 影像医学与核医学（专业学位）， 2022， 硕士

【摘要】 目的:探讨双层探测器光谱CT定量参数在肺孤立性良恶性结节中的诊断价值。材料和方法:2019年9月至2021年6月回顾性连续纳入孤立性肺结节58例,均于手术前或治疗前行双期光谱CT扫描,58例肺结节均有病理结果,并以病理结果作为金标准。基于光谱CT碘图和有效原子序数图,对病灶内部、病灶邻近肺组织及同水平层面正常肺组织进行碘浓度(IC)及有效原子序数(E-ff Z)的定量测量,同时测量同层面主动脉内碘浓度,计算标准化碘浓度(NIC)。以上数据在平扫CT及动脉期、静脉期三期分别测量。先对数据进行正态性检验(Shapiro-wilk,SW),符合正态分布的定量数据采用独立样本t检验,不符合采用秩和检验,比较分析在肺良性结节和恶性结节两组间进行比较。受试者工作特征曲线(ROC)评价光谱CT用于诊断肺结节良恶性的准确性。结果:1、58例肺结节中,43例恶性结节,15例良性结节。患者的临床特征,包括年龄、性别、有无吸烟史对于肺结节良恶性鉴别诊断差异无统计学意义。恶性结节患者年龄略大,男性者略多于女性。2、对于结节内部特征,动脉期NIC在两组之间差别具有统计学意义(P=0.030),恶性组高于良性组(恶性组NIC=0.11±0.08mg/ml,良性组NIC=0.07±0.03mg/ml),静脉期NIC与平扫E-ff Z在两组间差别无统计学意义(P值分别约0.167、0.291)。3、对于良恶性结节邻近肺组织灌注的影响,动、静脉期病灶侧肺组织IC、E-ff Z及病灶周围肺组织及同层面正常肺组织差值在良恶性两组间差别均有统计学意义(P<0.05)。4、ROC曲线评估光谱CT各参数对于肺良恶性结节诊断效能:病灶内部NIC、病灶邻近肺组织IC、E-ff Z及与同层面对应正常肺组织IC、E-ff Z差值的诊断效能均有一定的意义,其中动脉期病灶侧肺组织与对侧肺组织NIC差值曲线下面积最大(P=0.880),敏感性为90.0%,特异性为73.3%。结论:双层探测器光谱CT碘浓度和有效原子序数在肺良恶性结节鉴别诊断中有一定诊断效能,为肺结节诊断提供了一种新的工具。更多还原

【Abstract】 Objective:To investigate the diagnostic value of spectral CT quantitative parameters with double detector in solitary benign and malignant pulmonary nodules.Materials and Methods:From September 2019 to June 2021,58 cases of isolated pulmonary nodules were retrospectively and consecutively enrolled,all of which were scanned by dual-stage spectral CT before surgery or treatment.Pathological results were found in 58 cases of pulmonary nodules,and it was used as the gold standard.based on spectral CT iodine map and effective atomic number map,Iodine concentration(IC)and effective atomic number(E-FF Z)were quantitatively measured in lung leasions,adjacent lung tissues and normal lung tissues at the same level.Meanwhile,iodine concentration in aorta at the same level was measured.The above data were calculated by standard iodine concentration(NIC)and measured by plain CT and arterial phase and venous phase respectively First,the data were tested for shapiro-Wilk(SW).The quantitative data in conformity with normal distribution were tested by independent sample T test,while those in conformity with rank-sum test were compared.The accuracy of spectral CT in diagnosing benign and malignant pulmonary nodules was evaluated by receiver operating Characteristic curve(ROC).Results:1.Among 158 cases of pulmonary nodules,43 cases were malignant nodules and15 cases were benign nodules.There was no statistically significant difference in clinical characteristics,including age and gender,smoking history in the differential diagnosis of benign and malignant pulmonary nodules.Malignant nodules were slightly older,and males were slightly more than females.2.For the internal characteristics of nodules,NIC in arterial stage was significantly different between the two groups(P=0.030),and the NIC in malignant stage was higher than that in benign group(NIC in malignant group =0.11±0.08mg/ mL,NIC in benign group =0.07±0.03mg/ mL),and for NIC in venous stage and plain scan e-FF Z,there was no statistically significant difference in between the two groups(P = 0.167,0.291,respectively).3.For the influence of pulmonary tissue perfusion adjacent to benign and malignant nodules,the difference of IC and E-FF Z in pulmonary tissue adjacent to the lesion at the arteriovenous stage,the difference of lung tissue around the lesion and normal lung tissue at the same level between benign and malignant groups was statistically significant(P<0.05).4.ROC curve was used to evaluate the diagnostic efficacy of spectral CT parameters for benign and malignant pulmonary nodules:IC and E-FF Z of the lung leasions,leasions adjacent to lung tissue and difference were of certain significance.The area under curve NIC difference of lung tissue on the side of lesions and on the opposite side of lung tissue at arterial stage is the largest(P=0.880),the sensitivity was 90.0% and the specificity was 73.3%.Conclusion:The iodine concentration and effective atomic number of dual-detector spectral CT have certain diagnostic efficacy in the differential diagnosis of benign and malignant pulmonary nodules,providing a new tool for the diagnosis of pulmonary nodules.更多还原