双能量CT评估喉癌喉软骨侵犯的临床价值

摘要

目的:探讨双能量CT技术判断喉癌喉软骨侵犯的可行性.方法:回顾性分析经双源CT双能量扫描并经手术病理证实喉癌60例,其中单侧喉软骨侵犯28例,无喉软骨侵犯32例,评价碘图与常规增强图喉癌喉软骨侵犯征象(喉软骨硬化、溶解、侵蚀及外咽肿瘤扩散)的灵敏度及特异度;分别测量和比较动脉期、静脉期肿瘤、受侵软骨、正常软骨CT值、能谱曲线斜率及碘浓度.结果:碘图判断喉软骨溶解的灵敏度为92.3％,特异度为86.7％,判断侵蚀的灵敏度为82.4％,特异度为81.8％,较常规CT图像高(P＜0.05),判断喉软骨硬化、外咽肿瘤侵犯无差异(P＞0.05).肿瘤、受侵软骨、正常软骨不同时相CT值有差异(P＜0.05),但AUC均＜0.5.动、静脉期肿瘤、受侵软骨、正常软骨能谱曲线斜率及碘浓度有差异(P均＜0.05),且肿瘤碘浓度高于受侵软骨及正常软骨.能谱曲线斜率动脉期AUC为0.970,敏感度为88.9％,特异度为100％.静脉期AUC为0.944,敏感度为81.5％,特异度为96.3％.动脉期碘浓度AUC为0.995,敏感度为92.6％,特异度为100％,静脉期AUC为0.905,敏感度为77.8％,特异度为88.9％.结论:双源CT双能量碘图及动、静脉期碘浓度、能谱曲线斜率对判断喉癌喉软骨侵犯有一定的价值.%Objective:To explore the evaluation feasibility of laryngeal cartilage invasion in laryngeal carcinoma.Methods:Sixty cases with confirmed of laryngeal carcinoma were performed on dual energy CT,including 28 cases with unilateral laryngeal cartilage invasion and 32 cases without laryngeal cartilage invasion proved by operation and pathology were analyzed retrospectively.Evaluation of iodine overlay images and conventional enhanced images laryngeal cartilage invasion signs(laryngeal cartilage sclerosis,lysis,erosion and exralaryngeal tumor spread) sensitivity and specificity;Arterial and venous phase,invaded cartilage tumor and normal cartilage CT value and spectrum curve slope and iodine concentration were measured and compared.Arterial and venous phase,invaded cartilage tumor and normal cartilage CT value and spectrum curve slope and iodine concentration were measured and compared.Results:Iodine overlay images judging lysis of laryngeal cartilage the sensitivity was 92.3％,the specificity was 86.7％,the sensitivity of erosion was 82.4％ and the specificity was 81.8％,which was higher than that of conventional CT images (P＜0.05),judgment of laryngeal cartilage sclerosis,exralaryngeal tumor spread had no difference (P＞0.05).Tumor,invaded cartilage,normal cartilage at different time CT values were different (P＜0.05),but AUC were＜0.5.In the arteries and venous phase,there were differences in the spectral curve,slope and iodine concentration of the tumor,invaded cartilage and normal cartilage(P＜0.05),and the concentration of iodine in tumor was higher than that in invad ed cartilage and normal cartilage.The slope of the spectral curve,AUC in arterial phase was 0.970,sensitivity was 88.9％,specificity was 100％.The venous phase AUC was 0.944,the sensitivity was 81.5％,and the specificity was 96.3％.Arterial phase iodine concentration was AUC was 0.995,sensitivity was 92.6％,specificity was 100％,venous phase was AUC was 0.905,sensitivity was 77.8％,specificity was 88.9％.Conclusion:Dual energy CT dual energy iodine imaging and the concentration of iodine,the slope of the energy spectrum curve in the dynamic and venous phase are of some value in judging laryngeal cartilage invasion.