| [Objective]To detect the pulmonary nodules and masses with DSCT dual energy and dynamic enhancement technique.To explore the diagnosis and differential diagnosis of pulmonary nodules and masses, through the analysis of four energy software and T-DC curve obtained by dynamic enhancement.[Materials and methods]Experimental group:64patients with pulmonary nodule or mass were collect from April2012to March2013in the First Affiliated Hospital of Kunming Medical University, were divided into benign and malignant groups by the pathologic and clinical. Firstly, all patients were performed routine scan using DSCT with Flash mode, Then enhancement scan of arterial phase and nephrographic phase used by DSCT dual energy mode, then underwent the dynamic enhanced target scanning after injection of iodinated contrast material(Iopromide,370mgI/ml, injective rate3-4ml/s, at60s,120s,180s). Besides:64patients with pulmonary examining were collect from April to May2012. all patients were performed non-enhanced scan and enhancement scan using DSCT with conventional chest enhancement scanning mode.The the basic cases and different morphological features of benign and malignant pulmonary nodule or mass was compared. In "Liver VNC" mode to obtained the virtual nonenhanced and iodine-enhanced images, CT values, image quality(SNR,CNR), imaging feature of pulmonary nodule or mass on virtual nonenhanced (VNC) and Flash scan were compared. In "Lung Nodules" mode compared with Volume, Mean HU of VNC Volume, the increased CT values of nephrographic phase imaging features by ROC. Combined Lung PBV to analysis of perfusion abnormalities, the relationship of volume, position and perfusion abnormalities. From "Monoenergetic" software get power spectrum curve. Each phase of the CT values of dynamic contrast-enhanced (in arterial phase, parenchymal phase,60s,120s,180s)were compared,The PE, TTP, T-DC of dynamic contrast-enhanced the differences were compared between malignant, benign of non-inflammatory and inflammatory.[Result]1.64cases were40of males and24of females, with the age range of40-82years and mean age61.4+10.7years.2. Pathology result:In64case,43were malignant that included adenocarcinoma. n=26; squamous cell carcinoma, n=14; large cell neuroendocrine carcinoma, n=3;21benign that included tuberculosis, n=9; hamartoma, n=5; tuberculosis, n=4; the restes (sclerosing hemangioma, n=1; fungal infections,n=2).3. On the morphology, Lobulation, specular and pleural idendation were statistically significant (P<0.05in differential diagnosis of the benign and malignant. All of the signs were more common in malignant than in benign nodule or mass, the results significant difference between the two groups(P<0.05); the detectable rate of them were51.16%,76.74%and4.65%.4. To compare the VNC with Flash scan, there was no difference in the mean CT value, but the VNC scan had higher SNR,CNR, with significant difference between the two groups(P<0.05). There was no difference (P>0.05) in the detection rates of nodule or mass and morphological details, but it was only display5of the8cases of the calcification in VNC. The pure of Iodine images were show better for enhancing nodule or mass, especially the internal characteristics of high levels of iodine uptake nodule or mass5. The Volume, Mean HU of Volume, Mean HU of Iodine Volume, the increased CT values of malignant group were higher than the benign group, the results is significant difference between the two groups(P<0.05). Mean HU of VNC Volume was no statistically significant(P>0.05). Mean HU of Iodine Volume of filtration malignancy was26, and the sensitivity and the specificity were66.7%and83.3%. The increased CT values of parenchymal phase of filtration malignancy was23.7, and the sensitivity and the specificity were83.3%and42.9%.6. To Analysis of perfusion abnormalities(n=64), Perfusion abnormalities of pulmonary blood flow had12cases(central lung cancer); Perfusion abnormalities of lesions and its surroundings had52.7. The energy spectrum of the benign, malignant and inflammatory nodules and masses curve was obtained by "Monoenergetic" software. CT values of arterial, substantial,60s,120s and180s periods got by dynamic enhancement were compared. The differences of PE, TTP and T-DC were compared among the inflammatory, benign and malignant lesions.The attenuation curve of CT values of adenocarcinoma and squamous carcinoma was generally higher than TB. With the reduction of keV, the curve was quite difference. CT attenuation curve of inflammatory group was significantly higher than adenocarcinoma and squamous cell carcinomas. The energy spectrum of CT attenuation curve slope of adenocarcinoma, squamous carcinoma, tuberculosis and inflammatory group were compared. The corresponding energy spectrum of CT attenuation curve slope of adenocarcinoma and squamous carcinomas groups is close. There was no statistically significant difference (P>0.05). Otherwise, there was differences compared with each other(P<0.05).8. There was significant difference between the benign and malignant lesions (P<0.05) in the average of CT values (in nephrographic phase,60s phase); but no statistically significant(P>0.05) in the arterial phase. The average of CT values (at120s,180s) of benign lesions was statistically significant(P<0.05) with malignant, inflammatory lesions, but was not statistically significant(P>0.05) between the malignant and inflammatory lesions. PE of the3groups were statistically significant(P<0.05), PE of the malignant, inflammatory lesions were significantly higher than other benign lesions, but was not statistically significant(P>0.05) between the malignant and inflammatory lesions; TTP appeared in nephrographic phase(40-50s) to120s phase; TTP of the benign(about58%) and inflammatory lesions (about60%) appeared in120s phase, with statistically significant(P<0.05) among3groups.[Conclusion]1. There was significant difference between the benign and malignant lesions in the average of CT values, PE, TTP (in nephrographic phase,60s,120s,180s). T-DC of the malignant lesions are mainly type1,11. the inflammatory lesions are mainly type II,III.the non-inflammatory benign lesions are mainly type Ⅲ. The rate of malignant is100%of the type I.And the rate of benign is100%of type IV.2. The VNC scan has higher quality imaging and the radiation dose reduced. Meanwhile the pure of Iodine images are helpful to diagnosis enhancing lesions and provide more diagnostic information, the operation is simple and easy. But it could be underestimate part of the calcification.3. Lung PBV is helpless in differential diagnosis, but it is helpful for assess perfusion abnormalities and clinical.4. Mean HU of Volume, Mean HU of Iodine Volume, the increased CT values of malignant group were higher than the benign group, The specificity of mean HU of Iodine Volume was83.3%. The increased CT values of parenchymal phase the sensitivity and the specificity were83.3%.5. The power spectrum curve of DSCT was statistically significant among the malignant, inflammatory and non-inflammatory benign, but was not statistically significant in the malignant(eg. adenocarcinoma and squamous cell carcinoma)... |
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