双源CT双能量成像标准化碘浓度与肺癌TNM分期的关系

摘要

目的:探讨双源CT双能量成像技术标准化碘浓度(NIC)评价肺癌TNM分期的价值.方法:55例肺癌患者(55个病灶)采用双源CT常规平扫及双能增强扫描,获得肿块静脉期NIC.按病理结果将55例肺癌病例分为:肺腺癌组和肺鳞癌组;≤3cm肺癌组和＞3cm肺癌组;有转移组和无转移组;根据TNM分期分为I～Ⅱ期和Ⅲ～Ⅳ期两组.采用t检验比较各组观察指标的差异;将NIC分别与原发灶大小及TNM分期做相关性分析;采用受试者工作特征(ROC)曲线分析NIC对肺癌TNM分期的诊断效能.结果:肺腺癌组和肺鳞癌组的原发灶大小和NIC差异无统计学意义(P均＞0. 05);≤ 3cm肺癌组和＞3cm肺癌组的NIC差异无统计学意义(P＞0. 05);肺癌有转移组NIC高于无转移组,差异有统计学意义(P＜0. 05);肺癌NIC与原发灶大小无明显相关性(r=0. 106,P＞0. 05),与临床分期呈正相关(r=0. 681,P＜0. 05).以原发灶NIC为0. 296作为判断肺癌I～Ⅱ期和Ⅲ～Ⅳ期的诊断阈值(≤0. 296为I～Ⅱ期,＞0. 296为Ⅲ～Ⅳ期),诊断敏感度为96. 0％,特异度为73. 3％,符合率为 83. 6％.结论:采用双源CT双能量成像参数进行定量分析,对预测肺癌转移和评估TNM分期有较大价值.%Objective:To investigate the value of evaluation in TNM staging of lung cancer with normalized iodine concentration (NIC) of dual source CT dual energy imaging technology. Methods: 55 patients with 55 lesions in total received conventional plain scan and enhancement scan with dual source CT, in order to obtain the NIC in venous phase. According to pathology, lesions were divided into several groups including adenocarcinoma and squamous cell carcinoma, ≤3cm and＞3cm in size, with metastasis and without metastasis, TNM staging of stage I～Ⅱ and stage Ⅲ～Ⅳ. Using t-test to compare the difference of studied parameters in each group. Correlation analysis were used to compare NIC with tumor size and TNM staging respectively. ROC curve was used to estimate the diagnostic efficacy of NIC in TNM staging of lung cancer. Results: In adenocarcinoma group and squamous cell carcinoma group, no significant difference was found in primary tumor size and NIC (P＞0. 05),as well as NIC between ≤3cm group and ＞3cm group (P＞0. 05). Tumor with metastasis had higher value of NIC compared with that without metastasis (P＜0. 05). NIC of lung cancer had no significant correlation to primary tumor size (r = 0. 106,P＞0. 05) while it had positive correlation to clinical staging(r=0. 681,P＜0. 05). The diagnostic threshold of primary tumor NIC was 0. 296, which was an indicator to judge stage I～Ⅱ and stage Ⅲ～Ⅳ (≤0. 296 for stage I～Ⅱ,＞0. 296 for stage Ⅲ～Ⅳ). The sensitivity, specificity and coincidence rate for diagnosis was 96. 0％, 73. 3 ％ and 83. 6 ％ respectively. Conclusion: Quantitative analysis was helpful in predicting metastasis and TNM staging of lung cancer with parameters obtained with dual source CT dual energy imaging.