能谱CT在中央型肺癌伴阻塞性肺不张诊断及放疗定位中应用价值

刘秀丽; 张戟风; 刘景旺; 李健; 许美; 陈静

doi:10.15953/j.ctta.2022.164

能谱CT在中央型肺癌伴阻塞性肺不张诊断及放疗定位中应用价值

doi: 10.15953/j.ctta.2022.164

刘秀丽^1,,
张戟风¹,
刘景旺^2, ,,
李健²,
许美²,
陈静²

1.
沧州医学高等专科学校, 河北沧州061000
2.
开滦总医院影像科, 河北唐山063000

基金项目: 河北省医学科学研究计划（科技成果推广课题（20221580））。

详细信息

作者简介:
刘秀丽：女，沧州医学高等专科学校副教授，主要从事内科及影像专业教学，E-mail：2227593418@qq.com

刘景旺：男，开滦总医院影像科主任医师，华北理工大学教授、硕士研究生导师，主要从事放射医学诊断工作，E-mail：liujw1585@sina.com

通讯作者:
刘景旺*，

中图分类号: R 814
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- 文章访问数: 183
- HTML全文浏览量: 38
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- 被引次数: 0
出版历程
- 收稿日期: 2022-08-13
- 修回日期: 2022-10-02
- 录用日期: 2022-10-03
- 网络出版日期: 2022-10-21
- 刊出日期: 2023-07-31

The Value of Spectral CT in Differential Diagnosis and Radiotherapy Localiation of Central Lung Cancer with Obstructive Atelectasis

1.
Medicine College Level Specialty School of Cangzhou, Cangzhou 063100, China
2.
Radiology Department, Kai Luan General Hospital, Tangshan 063000, China

摘要

摘要: 目的：探讨能谱CT扫描在诊断中央型肺癌合并阻塞性肺不张及放疗前定位鉴别肿瘤边界、精准勾画靶区中的应用价值。方法：回顾性分析我院65例经病理证实的中央型肺癌伴阻塞性肺不张患者的放疗前定位 Ⅲ期能谱CT扫描的影像资料，比较分析Ⅲ期增强CT扫描不同参考指标（BMI、BMI-ICM及Eff-Z、PI）显示瘤-肺交界面评分值差异，比较肿瘤与不张肺组织IC值及CT值差异。结果：Ⅲ期增强CT扫描瘤-肺边界评分4项指标（BMI、BMI-ICM及Eff-Z、PI）间存在统计学差异，BMI-ICM最高，PI最低；动脉期、静脉期及延迟期 Ⅲ期扫描中，显示瘤-肺边界的主观评分有差异，动脉期最高；肿瘤与不张肺组织IC值及CT值差异具有统计学意义，IC值比CT值差别更大。结论：能谱CT扫描的不同指标能帮助鉴别中央型肺癌与不张肺组织的边界，利用最佳指标实现放疗前精准勾画放疗靶区，实现放疗计划最优化。
- 能谱CT /
- 肺癌 /
- 肺不张 /
- 放射治疗
Abstract: Objective: To investigate the value of spectral CT in differential central lung cancer from obstructive atelectasis for achieving the accurate delineation and radiotherapy localiation. Methods: The CT radiotherapy localiation images of three phase contrast enchancement by spectral CT of 65 patients confirmed by pathology with central lung cancer and obstructive atelectasis with were collected and analyzed. The scores and detection rates of tumor-lung interface between the polychromatic image (PI), the best monochromatic image (BMI), the effective atomic number (Eff-Z) and the best monochromatic image combined with iodine concentration map (BMI-ICM) were compared. Results: Statistical differences in the scores of tumor-lung interface were observed between PI, BMI, Eff-Z and BMI-ICM; the pairwise comparison showed that the subjective score of BMI-ICM was the highest, and PI was the lowest. The pulmonaty artery phase detection rates of tumor-lung interface of three phase contrast enchancement were the highest. There was statistical difference of iodine concentration (IC) and CT score between lung cancer and obstructive atelectasis. The difference of IC was higher than the CT score. Conclusion: Spectral CT is helpful to distinguish central lung cancer delineation from atelectasis. It provides a new method to delineate the radiotherapy localiation for radiotherapy plan of optimization.
- spectral CT /
- lung tumor /
- pulmonary atelectasis /
- radiotherapy

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图 1 左肺上叶中央型肺癌并左肺上叶不张混合能量平扫+增强扫描

Figure 1. The left upper lobe central lung cancer with obsrtuctive atelectasis of polychromatic image flat scan and enhancement

下载: 全尺寸图片幻灯片

图 2 左肺上叶中央型肺癌并左肺上叶不张单能量增强扫描及能谱曲线

Figure 2. The Spectral HU curve of the same patient and monochromatic image of 56 keV and 75 keV

下载: 全尺寸图片幻灯片

图 3 左肺上叶中央型肺癌并左肺上叶不张最佳单能量56 keV增强扫描碘基图及有效原子序数图

Figure 3. The best monochromatic enhancement image combined with iodine concentration map and effective atomic number image

下载: 全尺寸图片幻灯片

表 1 增强CT扫描各期PI、BMI及BMI-ICM瘤-肺边界主观评分的比较

Table 1. The scores and detection rates of tumor-lung interface of PI, BMI, BMI-ICM and Eff-Z in three phase contrast enchancement

扫描期相	瘤-肺边界主观评分值				统计检验
扫描期相	PI	BMI	BMI-ICM	Eff-Z	F	P
动脉期	2.51±0.83	3.14±0.85	3.84±0.31	3.04±0.55	34.28	＜0.01
静脉期	2.14±0.65	2.95±0.89	3.34±0.25	2.84±0.26	26.54	＜0.01
延迟期	2.12±0.55	2.54±0.35	3.04±0.85	2.74±0.15	18.32	＜0.01

下载: 导出CSV

表 2 增强CT扫描各期肿瘤与不张肺组织碘浓度IC值及CT值的比较

Table 2. The scores of tumor-lung interface of IC and CT scores in three phase contrast enchancement

扫描期相	组织IC/100 μg·mL^-1		CT值/HU		统计检验
扫描期相	肿瘤	不张肺组织	肿瘤	不张肺组织	t	P
动脉期	12.51±3.89	23.71±8.12	35.41±6.85	50.21±9.76	-4.89	＜0.01
静脉期	11.41±3.23	18.31±6.37	38.38±4.03	42.37±7.83	-6.43	＜0.01
延迟期	10.11±3.63	17.96±5.93	18.51±5.84	17.01±7.73	-6.82	＜0.01

下载: 导出CSV

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