| Objective: To investigate the application of spectral CT imaging in different lymphnode lesions,especially lymph node metastases, through the analysis about spectral featuresof lymph node paraffin-embedded tissues (PETs) and metastatic or non-metastatic lymphnodes of lung carcinoma.Part One the study of spectral CT imaging of lymph node paraffin-embedded tissues (PETs)Materials And Methods: Lymph node paraffin-embedded tissues (PETs) including13lymph nodes of lymphoma,13lymph nodes of tuberculosis,10lymph nodes of lungadenocarcinoma,13lymph nodes of lung squamous cell carcinoma,15lymph nodes of smallcell lung carcinoma and12non-metastatic lymph nodes of lung carcinoma were evaluatedby gemstone spectral imaging (GSI) CT scans. CT numbers of lymph nodes in themonochromatic images at11sets of keV levels (40-140keV,10keV step) and gradients ofspectral curves were measured. All results were analyzed with ANOVA.Result: Differences among CT numbers in the monochromatic levels from40to140keV: There were no differences in CT numbers from40to140keV between lungsquamous cell carcinoma and lymphoma and between small cell lung carcinoma andtuberculosis (P>0.05), yet the first two ones were significantly different from the last twoones in CT numbers from40to70keV (P<0.05); There were significant differences betweenlung adenocarcinoma and the others in CT numbers from60to140keV (P<0.05);Non-metastatic lymph nodes were significantly different from lymphoma in CT numbersfrom40to140keV, from small cell lung carcinoma in CT numbers from120to140keV,from tuberculosis in CT numbers from90to140keV and from lung squamous cellcarcinoma in CT numbers from50to70keV (P<0.05). The gradients of spectral curves ofsmall cell lung carcinoma, lung squamous cell carcinoma, lung adenocarcinoma,no-metastatic lymph nodes, lymphoma and tuberculosis were0.91±0.22,1.45±0.22,0.94±0.36,1.22±0.32,1.52±0.14and0.86±0.25. There were no significant differences ingradients of spectral curves between lung squamous cell carcinoma and lymphoma andamong small cell lung carcinoma, tuberculosis and lung adenocarcinoma (P>0.05).Non-metastatic lymph nodes were significantly different from the others in gradients ofspectral curves (P<0.05). Small cell lung carcinoma, tuberculosis and lung adenocarcinoma were significantly different from the others in gradients of spectral curves (P<0.05).Part Two The application of Spectral CT imaging in evaluation oflymph nodes metastasis of lung carcinomaMaterials And Methods: Six cases with small cell lung carcinoma (50lymph nodes),six cases with lung squamous cell carcinoma (40lymph nodes), four cases with lungadenocarcinoma (29lymph nodes), four cases with lung carcinoma without lymph nodesmetastasis (38lymph nodes) were evaluated by gemstone spectral imaging (GSI)with arterialphase and portal phase enhanced CT scan. At portal phase, CT numbers of lymph nodes inthe monochromatic images at11sets of keV levels (40-140keV,10keV step), gradients ofspectral curves and the iodine and water contents of these lymph nodes were measured. Allresults were analyzed with ANOVA.Result: Comparison among CT numbers in the monochromatic levels from40to140keV: non-metastatic lymph nodes> lung adenocarcinoma> small cell lung carcinomaand lung squamous cell carcinoma. There were significant differences betweennon-metastatic lymph nodes and other metastatic lymph nodes in CT numbers from40to90keV, between lung adenocarcinoma and small cell lung carcinoma in CT numbers from40to130keV and between lung adenocarcinoma and lung squamous cell carcinoma in CTnumbers from40to110keV (P<0.05). There were no differences in CT numbers betweensmall cell lung carcinoma and lung squamous cell carcinoma (P>0.05). The gradients ofspectral curves of small cell lung carcinoma, lung squamous cell carcinoma, lungadenocarcinoma and non-metastatic lymph nodes were-2.49±0.46,-2.38±0.42,-2.83±0.53,-3.46±0.92. There were no differences in gradients of spectral curves between smallcell lung carcinoma and lung squamous cell carcinoma (P>0.05). There were significantdifferences between non-metastatic lymph nodes and other metastatic lymph nodes, betweenlung adenocarcinoma and small cell lung carcinoma and between lung adenocarcinoma andlung squamous cell carcinoma in gradients of spectral curves (P<0.05). The iodine contentsof small cell lung carcinoma, lung squamous cell carcinoma, lung adenocarcinoma andnon-metastatic lymph nodes were (2.10±0.38),(2.00±0.35),(2.39±0.46),(2.91±0.78)g/L.There were no differences in iodine contents between small cell lung carcinoma and lungsquamous cell carcinoma (P>0.05). There were significant differences in iodine contentsbetween non-metastatic lymph nodes and other metastatic lymph nodes, between lungadenocarcinoma and small cell lung carcinoma and between lung adenocarcinoma and lung squamous cell carcinoma (P<0.05). The water contents of small cell lung carcinoma, lungsquamous cell carcinoma, lung adenocarcinoma and non-metastatic lymph nodeswere(1014.29±8.00),(1017.85±5.36),(1017.96±6.03),(1018.63±13.02)g/L. There wereno differences in water contents among these lymph nodes.Conclusion: Spectral CT imaging was helpful to evaluate lymph nodes lesions. It wasuseful to distinguish non-metastatic and metastatic lymph nodes of lung carcinoma by CTnumbers in the monochromatic at lower energy level, gradients of spectral curves and iodinecontents in material density images. |
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