Application Research Of Spectral CT Fuctional Imaging In Solitary Pulmonary Nodules And Assessing Lung Cancer Chemotherapy Effect

PART ? Diagnostic efficacy of the CT imaging spectroscopy and other factors in solitary pulmonary nodules.Objective Explore the relationship of isolated solitary pulmonary nodule energy spectrum CT quantitative parameter value,image morphology,the clinical data of patients with isolated pulmonary nodules nature,by multivariate Logistic regression analysis to screen out the probability of malignant solitary pulmonary nodules related to imaging data and clinical data for clinical solitary pulmonary nodules provide a basis for screening.Matrials and methods Prospectively collected in our hospital and 13 sub-centers between July 2014 to July 2015 lines,pathologically confirmed the nature of the solitary pulmonary nodule109 patients.The collect information including age,sex,smoking history,history of frequent exposure kitchen fumes,position to lesions,maximum diameter,with or without clinical symptoms,CEA(carcinoembryonic antigen serum)index,imaging findings and arteriovenous standardized iodine base period.All enrolled patients underwent dual-phase enhanced CT examination spectrum,automatically generate lesions on the arterial and venous arterial phase diagram of an iodine-based IC(ICAP)within the scope of ROI and venous phase IC(ICPP)by GSI Viewer software;simultaneous selection the same layer of the abdominal aorta IC as a standard reference value,each layer of tumor IC with the same ratio as the abdominal aorta IC tumor standardized iodine base value(n IC),respectively tumor arterial standardized iodine group(n ICAP)and vein of standardized iodine base value(n ICPP).Quantitative analysis of the energy spectrum CT parameters,image morphological data,the relationship between the clinical data and the nature of the solitary pulmonary nodule.Multivariate Logistic regression analysis utilizing the method of collecting the data were analyzed.Results1.Double Phase Enhanced Scan spectrum got arteriovenous phase IC and n IC,benign and malignant pulmonary nodules spectrum quantitative parameters were compared spectroscopy parameters malignant group was higher than benign group,the differences were statistically significant.2.109 cases of patients with solitary pulmonary nodules,benign and malignant nodules with age,smoking history,CEA index,maximum diameter,morphological signs of lobulation,burr sign,pleural indentation and spectrum parameters ICAP correlation ICPP,n ICAP,n ICPP statistically significant(P <0.05);benign and malignant solitary pulmonary nodules with sex,lesion,kitchen smoke exposure history,clinical symptoms and morphological signs of smooth edge,calcification,no statistically significant correlation between vacuole and bronchogram factors(P> 0.05).3.The patient's age,the maximum diameter,image morphological signs of leaf sign,sign and burr n ICAP,n ICPP is benign and malignant solitary pulmonary nodules constitute an important risk factor ratio.Conclusions1.Two periods of iodine concentration(IC),the standard iodine concentration (NIC)and the difference between benign and malignant SPN has statistical significance.2.Age,the maximum diameter of the nodule,the signs of the imaging signs,burr and when NICAP > 0.18,NICPP > 0.24,these are risk factors for SPN benign and malignant performance,which can be used as an important basis for judging SPN.3.Sites of benign and malignant SPN and its difference was not statistically significant,but the probability of the occurrence of lung cancer compared with the contralateral high,while the lungs of the highest probability of cancer leaves replaced senescent,the right side is the;lower lobe of the right lung malignancy rate of SPN high;right middle lobe malignant SPN rate is relatively lowPART ? Application of one-stop CT perfusion imaging spectroscopy in isolated pulmonary nodules or masses and its correlation with angiogenesis in lung cancerObjective To investigate the different characteristics of perfusion parameters and energy spectra of benign and malignant lesions of lung,the diagnostic value of different parameters is compared,finding the best diagnostic parameters and the optimal combination parameters of different methods;at the same time,the correlation between parameters and microvessel density was analyzed,objective to provide an objective basis for the study of hemodynamics in benign and malignant lung lesions.Matrials and methods43 cases of pulmonary benign and malignant nodule or lump were hospitalized patients with one stop CT energy spectrum perfusion imaging,all the reconstructed image is transmitted to the GE AW4.6 postprocessing workstation.Select delay 30s(the first 12 pass),60s(the first 27 pass)as the arterial phase(arterial phase,AP)and venous phase(venous phase,VP),image reconstruction select 70 ke V,ASIR40%,thickness of 1.25 mm.Using GSI Viewer analysis software to measure arterial IC in the range of ROI in the arterial phase and portal venous phase(ICAP)and iodine kitu on venous phase IC(ICPP);at the same time with the aortic IC reference value as the standard,the IC ratio of each stage of nodule or mass IC with the same layer as the standard iodine based aortic nodule or mass value(NIC),respectively.Analysis nodule or mass in the arterial and venous phase among 40 ke V ~ 70 ke V,70 ke V ~100ke V,100 ke V ~ 140 ke V spectrum slope.The receiver operating characteristic(ROC)analysis of CT perfusion parameters and spectrum parameters in differential diagnosis of benign and malignant nodules or masses,with the area under the curve as the evaluating standard of value judgment,obtain the maximum Youden index and select the best diagnostic threshold,the sensitivity and specificity of calculation.Results1.This study group of 43 patients with different malignant pulmonary nodules or masses of BV,BF and PS were significantly higher than that in benign group,the differences were statistically significant(P=0.001,0.002,0.041);compared with the benign group of malignant group MTT,the difference was not statistically significant(P=0.411).2.Malignant arterial phase IC and n IC group were higher than the benign group(P = 0.003,0.002),the difference was statistically significant;vein of malignant IC and n IC always make higher than the benign group(P < 0.001 ? P=0.001),the difference was statistically significant.Arterial phase 40 ~ 70 ke V slope between malignant group and benign group had statistically significant difference(P=0.025),70-100 ke V,100 ~ 140 ke V slope between the two groups was not statistically significant(P=0.051,0.541),venous phase 40 ~ 70 ke V,70 ~ 100 ke V slope of significant difference between the two groups(P=,0.001 0.007),100 ~ 140 ke V slope between the two groups was not statistically significant(P=0.226).3.The area under the curve of BV was the largest in the 43 cases of pulmonary lesion perfusion parameters,when the threshold value of BV was 10.93,the sensitivity of diagnosis of malignant nodules was 87.5%,and the specificity was 55.56%;when the BF threshold value was 69.48,the sensitivity was 93.75%,and the specificity was 47.6%;while BV,BF two parameters for ROC curve comparison,P=0.9549 > two,0.05 parameters of lung lesions benign and malignant diagnosis is no difference.The area under curve of NICPP is 0.806,which is the largest,the threshold value is 0.15,the diagnosis of malignant nodules,excluding benign nodules of 56.25%,specificity of 96.30%.4.BV,n ICPP as arguments both for diagnosing joint benign and malignant pulmonary nodules,to arrive at a predicted probability PRE-1,the predicted probability PRE-1 and BV,n ICPP respectively compare by ROC curves obtained predicted probability PRE-1ROC the area under the curve of 0.931,and the area under the curve of BV and NICPP(0.774,0.806)was larger than that.5.Among 35 cases of surgery,malignant group of MVD was greater than the benign group of MVD(P=0.008<0.05),the difference was statistically significant.BF,BV and PS were positively correlated with MVD(both P<0.05),among which BV was the most significant,and the correlation coefficient was highest(r=0.695,0.76).ICAP,ICPP and MVD were positively correlated(both P<0.05),and the two groups were significantly ICPP,the correlation coefficient was higher(r=0.641,0.762).Conclusions1.One-stop CT perfusion imaging spectroscopy techniques can be used in solitary pulmonary nodule or mass differential diagnosis of benign and malignant.2.The BV,BF and PS values of malignant pulmonary solitary nodules or masses were higher than those of benign pulmonary solitary nodules or masses with CT perfusion imaging,and the three were statistically significant.The value of BV in the diagnosis of solitary pulmonary nodules or masses has a relatively high diagnostic value.3.The CT and NIC of the and IC in the dynamic venous phase were statistically significant,but the area under the ROC curve of NICPP was larger and the diagnostic accuracy was higher.The slope of the 70 ~ 70 ke V and the venous phase of the dynamic and venous phase of the energy spectrum curve is helpful to distinguish the benign and malignant tumors of the lung.4.One-stop CT perfusion imaging spectroscopy techniques can obtaine plurality of by combining perfusion and spectroscopy spectrum,united perfusion parameters BV and spectrum parameters NICPP identification solitary pulmonary nodule or mass of benign and malignant has a high diagnostic value,the sensitivity and specificity were 87.5% and 88.89%.5.Pulmonary solitary nodule or mass of perfusion and energy spectrum parameters except MTT were correlated with MVD,and the correlation coefficient of NICPP and BV was higher.PART ? Application of one stop CT energy spectrum perfusion imaging in evaluating the efficacy of lung cancer chemotherapyObjective The scanning of one stop CT energy spectrum perfusion imaging in patients with lung cancer before and after chemotherapy,the tumor energy spectrum and perfusion parameters were analyzed and compared with the tumor volume,to investigate the effect of one stop CT energy spectrum perfusion imaging in the evaluation of early stage chemotherapy for lung cancer.Matrials and methods23 cases of lung cancer confirmed by pathology were collected from the First Affiliated Hospital of Zhengzhou University between April 2016 and November 2014.Chemotherapy a week before and one week after the end of chemotherapy,a one-stop CT perfusion imaging scan spectra were measured in the longest diameter and tumor perfusion parameters,quantitative CT spectrum parameter values,and analyze the changes.Evaluation of efficacy of chemotherapy based on RECIST standard.Using independent samples t test or paired t test to analyze the difference between the maximum diameter,the perfusion parameters and the value of the parameters of the tumor,and the difference between the effective group and the ineffective group before and after chemotherapy.The relationship between the maximum diameter of the tumor,the perfusion parameters and the quantitative parameters of the energy spectrum RECIST and the CT standard.To explore the feasibility of one stop CT energy spectrum perfusion imaging for evaluating the efficacy of chemotherapy in patients with lung cancer.Results1.23 cases of lung cancer,compared tumor size between 15 cases of effective group and 8 cases of ineffective group before and after chemotherapy,the difference was no significant.15 cases effective group liquefaction necrosis occurred in 2patients the lesion.2.Early chemotherapy effective group CT perfusion parameters BV,BF value compared with before treatment,and the differences were statistically significant(P =0.012,0.009 <0.05);MTT and PS value and the value of those before treatment and after treatment was not statistically significant(P = 0.151,0.063> 0.05).After the effective group therapy ICAP,ICPP,NICAP,NICPP value than that before chemotherapy lower,the difference was statistically significant(P = 0.039,0.010,0.047,0.015<0.05).3.After chemotherapy,the CT perfusion parameters BV and BF values were decreased compared with before treatment,the difference was statistically significant(P = 0.003?0.009<0.05);there was no significant difference between the PS value and MTT value before and after chemotherapy(P = 0.516?0.433> 0.05).After treatment,the ICAP,ICPP,NICAP and NICPP values were slightly higher than before treatment,the difference was not statistically significant(all P > 0.05).Comparison of ICAP,ICPP,NICAP and NICPP between two groups before and after chemotherapy in patients with lung cancer,P values were > 0.05,the difference was not statistically significant;after chemotherapy,the effective group ICap and NICap were less than the invalid group(P=0.002 ? P < 0.001),the difference was statistically significant.4.Effective group of lung cancer treatment before the BF value is greater than the invalid group,the difference has statistical significance(P=0.014<0.05);there was no significant difference.In BV,PS and MTT values between the effective group and the ineffective group before the treatment of lung cancer(P=0.052?0.077?0.362> 0.05).To compare the relationship between the changes of BF value and the remission rate after chemotherapy.The remission rate of BF was 81.2%,and the remission rate was 28.5% in the group with the increase of BF value,the difference was statistically significant(P=0.007<0.05).Conclusions1.The therapeutic effect of lung cancer is limited by the change of lesion size after chemotherapy,the changes of the energy spectrum parameters and perfusion parameters can be obtained from the functional point of view to evaluate the microcirculation of the lesions,it can provide an effective complement to the evaluation criteria for the treatment of solid tumors.2.Lung cancer treatment before the high perfusion status,after the treatment of tissue perfusion and reduce the value of BF is relatively sensitive to chemotherapy,remission rate is high;the increase in the value of the arterial phase after treatment may prompt the progress of lung cancer.