| Object: This study is to analyze the feasibility of CT diagnosis of benign and malignant nodules and lumps in the lung,using energy spectrum CT multi-parameter imaging technology(including iodine concentration,slope of energy spectrum curve,70 kev single energy CT value and effective atomic number),to explore the application of diagnosis and differential diagnosis of energy spectrum CT in the benign and malignant lung nodules and lumps.Materials and Methods: Part I: Diagnostic Value of Spectral CT Imaging in Atypical Tuberculosis Ball and Lung Cancer 11 cases of pulmonary tuberculosis and 34 cases of lung cancer patients of pathologically confirmed get on energy spectrum CT scan: unenhanced scan,arterial phase(AP)scan and venous phase(VP)scan.unenhanced scan,arterial phase and venous phase images were reconstructed by thin slices of energy spectrum,and sent them to the ADW(Advanced Workstation)4.6 workstation.Double-blind method measured the energy spectrum parameters.The CT values of unenhanced scan,arterial phase and venous phase iodine concentration(IC),arterial phase and venous phase curve(λHU)were measured at 70 ke V thin layer energy spectrum,while measuring the iodine concentration(IC artery)of same level aortic phase of the descending aorta or subclavian arta.The normalized iodine concentration(NIC)and the net increase CT value of arterial phase,venous phase of 70 ke V thin layer image were calculated.Region of interest(ROI)was placed in the lesion density uniformity level,and avoid empty,calcification and blood vessels.All data were measured at three consecutive ROI levels and had taken the average to ensure the data as accurate as possible.Part II: The differential Diagnosis of Spectral CT Imaging in Inflammatory Diseases and Lung Cancer 49 cases of lung nodules and lumps patients(15 cases of pneumonia and 34 cases of lung cancer)pathologically confirmed get on energy spectrum CT scan.First of all,unenhanced scan was get in energy spectrum mode.Then the pulmonary arterial phase and the aortic phase were scanned in energy spectrum mode at 8s-16 s and 25s-32 s after contrast agent injection,respectively.unenhanced scan,pulmonary arterial phase and aortic phase images were reconstructed by thin slices of energy spectrum,and sent them to the ADW4.6 workstation.Double-blind method measured the energy spectrum parameters.The CT values and IC of unenhanced scan,pulmonary arterial phase and aortic phase were measured at 70 ke V thin layer energy spectrum image.the net increase IC(d IC)and the net increase CT value of pulmonary arterial phase and aortic phase at 70 ke V thin layer energy spectrum image were calculated.ROI was placed in the lesion density uniformity level,and avoid empty,calcification and blood vessels.All data were measured at three consecutive ROI levels and had taken the average to ensure the data as accurate as possible.Results: Part I: Diagnostic Value of Spectral CT Imaging in Atypical Tuberculosis Ball and Lung Cancer 1)CT results:11 patients with tuberculous ball were considered lung cancer before the pathological results.5 cases were not typical of the distribution,respectively,in the anterior segment of the anterior segment,the middle and lower lobe of the basal segment;4 cases can be seen lobulation;5 cases of different degrees of burr-like protrusion;9 cases without calcification;Satellite stove;3 cases were significantly enhanced.2)Energy spectrum parameters:Lung cancer group was higher than the atypical tuberculosis group,on NIC,the net increase CT values of 70 Ke V images and λHU(AP and VP),the difference was statistically significant(P <0.05);But there was no significant difference between the unenhanced CT values(P> 0.05).3)Energy spectrum parameters ROC curve analysis: Selecting the energy spectrum parameters of statistical significance generated the ROC curve,and get the best diagnostic threshold,sensitivity and specificity of the corresponding energy spectrum parameters.In this study,the diagnostic value of NIC is the biggest,when the threshold is 0.105,sensitivity and specificity are 82.4% and 90.9% respectively.Part II: The differential Diagnosis of Spectral CT Imaging in Inflammatory Diseases and Lung Cancer 1)Energy spectrum parameters: To compare The spectrum parameters between the inflammatory lesion group and the lung cancer group: The d CT of the IC,d IC and 70 ke V images in pulmonary arterial phase were in the order of(11.95±2.52 and 6.40±3.18),(9.77±2.13 and 4.23±2.51)(100ug/ml)and(11.70±3.41 and 6.16±3.75)HU;The IC and d IC were(23.36±5.37 and 15.84±4.65)and(21.18±6.06 and 13.64±3.29)(100ug/ml)in aortic phase,respectively.Inflammatory diseases group was higher than lung cancer group above spectrum parameters,and the difference was statistically significant(P <0.05).The d CT value and effective atomic number of the 70 ke V in aortic phase were (35.64±9.30 and 29.11±12.83)(100ug/ml)and(7.70±0.17 and 7.71±0.18),respectively,and the difference was not statistically significant(P> 0.05).2)Energy spectrum parameters ROC curve analysis: Selecting the energy spectrum parameters of statistical significance generated the ROC curve,and get the best diagnostic threshold,sensitivity and specificity of the corresponding energy spectrum parameters.In this study,the diagnostic value of NIC is the biggest,when the threshold is 0.105,sensitivity and specificity are 82.4% and 90.9% respectively.In this study,the diagnostic value of d IC in pulmonary arterial phase is the biggest,when the threshold is 7.385(100ug/ml),sensitivity and specificity was 93.3% and 91.2%,respectively.Conclusion: 1)Iodine concentration value,70 ke V single energy CT value and energy spectrum curve slope are helpful to the atypical tuberculosis ball and lung cancer differential diagnosis.In particular,the NIC value is higher.2)Iodine concentration value and 70 kev single energy CT values contribute to the differential diagnosis of inflammatory lesions and lung cancer,especially d IC in the pulmonary artery is higher. |
PDF Full Text Request