| Objectives:1、To analyze the spectrum curve characteristic of necrotic squamous cell carcinoma metastatic lymph nodes and lymphoid tuberculosis. And explore the significance of dual energy CT in differential diagnosis of cervical lymph nodes.2、 The multi parameter of cervical squamous cell carcinoma metastatic lymph nodes on dual source dual energy CT imaging were analyzed, to explore the value of dual energy imaging in differential diagnosis of cervical squamous cell carcinoma metastatic lymph nodes differentiation degree.3、To investigate the value of dual energy CT for small metastatic central lymph nodes in patients with papillary thyroid cancer.Methods:Image data of 94 cases with a total of 263cervical lymph node lesions by pathology underwent dual energy enhanced CT scan were retrospectively analyzed. All patients underwent routine plain scan, arterial and parenchymal dual energy scanning, and the Sn140kV,80kV, and weighted linear fusion 120kV images were obtained. Processed images with post processing software called "Liver VNC" which is in MMWP post-processing workstation, generating iodine map in both arterial and venous phase, the iodine concentration and normalized iodine concentration of the lymph nodes lesions was measured. Processed images with post processing software called "Mono Energetic" which is in MMWP post-processing workstation, generating spectrum energy curve. Then observed the change trend of the spectrum curve and comparison the different kinds of lymph node energy spectrum curve slope. The lymph node metastasis of cervical squamous cell carcinoma, lymph node tuberculosis and papillary carcinoma metastatic lymph nodes were compared and studied. As follows:1、Image data of 25 cases with a total of 81 cervical lymph node by pathology underwent dual energy enhanced CT scan were retrospectively analyzed. Processed images with post processing software called "Mono Energetic" which is in MMWP post-processing workstation, generating spectrum energy curve. The trend of the spectrum curve was observed and the spectrum curve slope of the necrotic area and parenchyma of two kinds of lymph nodes were compared.2、Twenty-nine patients with one hundred and five cervical enlarged lymph nodes were analyzed respectively. All the patients enrolled underwent contrast enhanced CT spectral scan in both arterial and venous phase iodine concentration and standardized iodine concentration (NIC) from low differentiated and high differentiated cervical squamous cell carcinoma metastatic lymph nodes were measured and compared.3、43 papillary carcinoma of the thyroid patients cases with a total of 119 small metastatic central cervical lymph nodes in by pathology underwent dual energy enhanced CT scan were retrospectively analyzed. The short diameter, iodine concentration and standardized iodine concentration (NIC) of both metastatic central cervical lymph nodes and non-metastatic lymph nodes were measured. The slope of the energy spectrum was calculated, and the difference between the two groups was compared in iodide concentration, the standard iodine concentration (NIC) and the slope of the energy spectrum curve.Results:1、Of all 81 lymph nodes, there were 42 squamous cell carcinoma metastatic lymph nodes and 39 lymphoid tuberculosis. In the range from 60 keV to 180 keV, CT value of the parenchyma of the two kinds of lymph nodes decreased with increase of keV value. It showed the higher the keV value the less CT value decreased, with the energy spectrum curve of "drop type". But there was a significant difference of CT value only in 60-70 keV(p<0.05). The spectrum curve of necrosis of the squamous cell carcinoma metastatic lymph nodes were "drop type". The spectrum curve of necrosis of lymphoid tuberculosis were "rise type". The energy curve slope of parenchyma of two different nature of necrotic cervical lymph nodes were 0.75±0.23 and 0.58±0.33, were statistically significant(p<0.05).The energy curve slope of necrosis of two different kinds of cervical lymph nodes were 0.16±0.20 and-0.02 ±0.29, were statistically significant(p<0.05).2、Statistically significant differences of standardized iodine concentration (NIC) were found between the low differentiated and high differentiated cervical squamous cell carcinoma metastatic lymph nodes at arterial phase and venous phase(P<0.05). Among them, low differentiated squamous cell carcinoma metastatic lymph nodes of high standardized iodine concentration. The iodine concentration at venous phase showed significant difference between the two groups(P<0.05). however, differences of iodine concentration at arterial phase between the two groups were not statistically significant (P<0.05).3、There were 55 thyroid papillary carcinoma metastasis lymph nodes,64 non-metastatic lymph nodes. There were significant differences in the mean short diameter of the lymph nodes of the two lymph nodes(p<0.05). In the arterial phase and venous phase, the average iodine concentration and NIC were higher than that in non metastatic lymph nodes.The difference was statistically significant(p<0.05). The AUC under ROC of iodine concentration and normalized iodine concentration were 0.623 and 0.729 in arterial phase, respectively; The AUC under ROC of iodine concentration and normalized iodine concentration were 0.606 and 0.627 in venous phase, respectively. There were significant differences of the mean value of spectrum curve slope at arterial phase (P>0.05). The mean value of spectrum curve slope had no statistical difference at spectrum venous phase (P<0.05)Conclusions:1、Spectrum curve in arterial phase from dual-energy scan has certain reference value for differential diagnosis of two types different of necrotic cervical lymph node.2、The standardized iodine concentration of dual energy imaging can be used to differentiated degree of cervical squamous cell carcinoma metastatic lymph nodes.3、 There are differences in iodine concentration, NIC and curve slope from dual-energy in different nature of the small thyroid papillary carcinoma small metastatic central cervical lymph nodes at both arterial phase and venous phase.Dual energy CT technology has a certain value for the identification of small central cervical lymph nodes and small non-metastatic lymph nodes. |
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